When it comes to explaining success of artificial methods for aiding to conceive, it is an arduous exercise to quote the success rates without causing certain amount of disappointment to the waiting couples. The success rate for natural or artificially aided intrauterine insemination comes out to be between 10-20% elicitated from a number of studies. However, the female reproductive fecundibilty in a completely healthy anovulating patient with unexplained infertility coupled with a fertile male comes out to be 15% approximately over one ovulatory episode. Patients undergo vast array of emotions from disappointment to honest surprise over the limitations of aided medical methods.
This puts us in a perspective of knowing, how many times should intrauterine insemination (IUI) be attempted before considering more advanced aggressive methods considering the patient's age and fertility go side by side.
The rate of success per IUI cycle declines linearly with advancing female age, with an observed clinical pregnancy rate of 5% to 8% among women 41 to 42 years old .
However, besides female age, additional criteria should be considered to determine which patients are most likely to benefit from initial treatment with IUI and how many cycles are reasonable to attempt before recommending IVF/ICSI treatment.
Naturally, semen parameters are another variable that alone or in combination might be able to predict pregnancy in an IUI cycle.
Muthigi et al reported the relationship between postwash total motile sperm count (TMSC) and pregnancy in ovulation induction/ intrauterine insemination (OI/IUI) cycles in a study published in Fertility and Sterility Journal. In this retrospective cohort study from a single large fertility clinic, the authors observed
- The clinical pregnancy rate was highest when TMSC was >=9 million and that a gradual linear decline in clinical pregnancy rates occurred as TMSC decreased.
- The clinical pregnancy rate per cycle was approximately 16% when TMSC was >=9 million and declined to approximately 4% when TMSC was <0.25 million.
- Variables that were significantly associated with increased clinical pregnancy rates per cycle included lower female age, lower body mass index, and non-first IUI cycle; the rate was 15.5% for the first cycle, compared with 15.9% for the second cycle (P<0.001).
These results showed that a postwash TMSC >=9 million is associated with the highest chance of clinical pregnancy in an OI/IUI cycle.
The data also showed no diminishment in success rates over six cycles of IUI.
The decision about how many IUI cycles to complete or when to proceed to IVF/ICSI should be made by the patient and physician based on individual circumstances.
The study suggested "One therapeutic option that can therefore be considered in men with a low postwash TMSC is the pooling of sequential ejaculates. This can increase the total number of motile sperm by 144% in men with a normal sperm count and by 329% in oligospermic men. This strategy could be a low-cost way to reduce the time to pregnancy in this population and decrease the number of treatment cycles needed."
To summarize, Muthigi et al. helped to clarify the association between postwash TMSC and the rate of clinical pregnancies per IUI cycle.
"There is a threshold of TMSC below which the pregnancy rate declines linearly. There was no absolute TMSC for which there was zero chance of pregnancy, and therefore even partners of men with a severely low TMSC are candidates for IUI treatment, especially young partners."
These data should be used going forward, in addition to other important variables, such as the woman's age and infertility diagnosis, when making management decisions with patients and to help frame their expectations for the predicted chance of success per cycle. Future studies should evaluate low-risk, low-cost interventions that can increase pregnancy rates for partners of men with low TMSC that can be offered before proceeding to IVF/ICSI treatment.
For further reference log on to:
https://doi.org/10.1016/j.fertnstert.2021.03.013
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