Intrauterine insemination (IUI) pregnancy outcome is enhanced by shorter intervals from semen collection to sperm wash, from sperm wash to IUI time, and from semen collection to IUI time

Abstract

Objective: To determine whether IUI pregnancy was affected by [1] place of semen collection (home vs. clinic), and [2] intervals from collection to sperm wash (C-SW), from sperm wash to IUI (SW-IUI), and from collection to IUI (C-IUI).

Design: Retrospective study.

Setting: Infertility clinic.

Patient(s): Sixty-two couples in 132 cycles.

Intervention(s): Clomiphene citrate (CC) or hMG, plus hCG, and IUI.

Main outcome measure(s): Ultrasonographic detection of fetal heart beat(s).

Result(s): Semen collection at clinic resulted in a higher pregnancy rate than collection at home in hMG-treated (44% vs. 18%; P=.03) but not in CC-treated women (9% vs. 9%; P=.93). Intervals of C-SW, SW-IUI, and C-IUI were shorter in pregnant than in nonpregnant hMG-treated women (27 vs. 41 minutes, 42 vs. 85 minutes, and 99 vs. 156 minutes, respectively; P< or =.01) but not in CC-treated women (28 vs. 38 minutes, 51 vs. 63 minutes, and 109 vs. 131 minutes, respectively; P> or =.19). Semen processed within 30 minutes after collection resulted in a higher pregnancy rate than that processed 31-60 minutes after collection in hMG-treated (48% vs. 18%; P=.02) but not in CC-treated women (10% vs. 8%; P=.81). Intrauterine insemination performed within 90 minutes of collection resulted in a higher pregnancy rate than IUI performed at 91-120 minutes or >120 minutes after collection in hMG-treated (99% vs. 22% and 7%, respectively; P<.0001) but not in CC-treated women (11%, 4%, and 10%, respectively; P> or =.46).

Conclusion(s): For i.u.i. with hMG but not CC, semen collection at the clinic is more effective than, and should be chosen over, collection at home. Delaying semen processing from 30 minutes up to 1 hour and/or delaying IUI from 90 minutes up to 2 hours after collection compromises the pregnancy outcome in hMG-IUI cycles. Semen specimens should be processed as soon as just after liquefaction and within 30 minutes of collection, and IUI performed as soon as just after processing and within 90 minutes of collection.