Influence of follicle rupture and uterine contractions on intrauterine insemination outcome A new predictive model

Capsule:
Follicle rupture and the number of uterine contractions observed after intrauterine insemination are positively correlated with clinical pregnancy and live birth rates. A prediction model was built including these variables.

Authors:
Víctor Blasco, M.Sc., Nicolás Prados, Ph.D., Francisco Carranza, M.D., Cristina González-Ravina, Ph.D., Antonio Pellicer, M.D., Ph.D., Manuel Fernandez-Sanchez, M.D., Ph.D.

Volume 102, Issue 4, Pages 1034-1040

Abstract:

Objective:
To correlate the detection of follicle rupture and the number of uterine contractions per minute with the outcome of IUI and to build a predictive model for the outcome of IUI including these parameters.

Design:
Retrospective cohort study.

Setting:
Fertility clinic.

Patient(s):
We analyzed data from 610 women who underwent homologous or donor double IUI from 2005 to 2010 and whose data of uterine contractions or follicle rupture were recorded.

Intervention(s):
None.

Main Outcome Measure(s):
Live-birth rate.

Result(s):
Nine hundred seventy-nine IUI cycles were included. The detection of follicle rupture (odds ratio [OR], 1.98; 95% confidence interval [CI], 1.30–3.01) and the number of uterine contractions per minute (OR, 1.67; 95% CI, 1.02–2.74) assessed after the second insemination procedure of a double IUI were positively correlated with the live-birth rate. A multiple logistic regression model showed that sperm origin, maternal age, follicle count at hCG administration day, follicle rupture, and the number of uterine contractions observed after the second insemination procedure were significantly associated with the live-birth rate.

Conclusion(s):
Follicle rupture and uterine contractions are associated with the success of an IUI cycle. This may open new possibilities to improve the methodology of IUI.

  • Manuel Fernandez-Sanchez

    Thank you, Dr Palter. I agree with you that we don’t have evidence enough to consider a 3rd IUI or a new hCG dose as effective strategies. We neither perform them. In fact, I think that only one insemination could be equally effective if we have knowledge enough about the optimal timing to do it. The two main conclusions after our data are: may be that, in those cases in which we don’t see those “peri-ovulatory” signs, as follicle rupture at the adequate time, we could be detecting a sub-group of patients with worse prognostic with IUI. And, something relevant: uterine contractions seems to be beneficial for IUI, in the opposite way than for IVF. Could this fact open a new door to explore a potential way to improve IUI results? In my opinion, it would be very interesting to explore that in the future. Thanks. Manuel.

  • Dr Fernandez-Sanchez– this is a very interesting study– in clinical practice do you always check for follicular rupture at the second insemination? what do you do if you see it has not ruptured? I recall older studies suggesting it was not predictive of pregnancy rates and most centers have abandoned second hcg dosing and third IUIs

  • Guest

    Dr Fernandez-Sanchez– this is a very interesting study– in clinical practice do you always check for follicular rupture at the second insemination? what do you do if you see it has not ruptured? I recall older studies suggesting it was not predictive of pregnancy rates and most centers have abandoned second hcg dosing and thrid IUIs

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