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. 2022 Dec;39(12):2811-2818.
doi: 10.1007/s10815-022-02636-4. Epub 2022 Nov 7.

Optimizing pregnancy outcomes in intrauterine insemination cycles by stratifying pre-wash total motile count and patient-specific factors: a patient counseling tool

Catherine E Gordon  1 , Karissa C Hammer  2 , Kaitlyn James  3 , Andrea Lanes  1 , Stylianos Vagios  3 , Anabel Starosta  4 , Mark Hornstein  1 , Irene Souter  3
Affiliations

Optimizing pregnancy outcomes in intrauterine insemination cycles by stratifying pre-wash total motile count and patient-specific factors: a patient counseling tool

Catherine E Gordon et al. J Assist Reprod Genet. 2022 Dec.

Abstract

Purpose: The purpose of this study is to clarify which pre-wash total motile count are associated with improved clinical pregnancy rate (CPR) and live birth rate (LBR) based on maternal age, AMH level, stimulation regimen, and infertility diagnosis.

Methods: This was a retrospective cohort study of first completed IUI cycles at two academic fertility centers from 5/2015 to 9/2019. Cycles were stratified by pre-wash TMC, maternal age, AMH level, stimulation regimen, and infertility diagnosis. The primary outcome was CPR and secondary outcomes were live birth and miscarriage.

Results: One thousand one hundred fifty-four cycles were analyzed. Of the 162 cycles that resulted in a CPR (14.0%), most had an insemination TMC > 20 million. Compared to TMC > 20 million, there was no difference in CPR or LBR for lower TMC categories, excluding the TMC < 2 million group, in which there were no pregnancies. When TMC was stratified by deciles, there was also no difference in CPR and LBR, including within the lowest decile (TMC 0.09-8.6 million). Younger age and higher ovarian reserve parameters were associated with higher pregnancy and LBR when stratified by TMC. There was no difference in pregnancy and LBR when considering different stimulation protocols.

Conclusions: Our data suggest that pregnancy and LBR are equivalent above a TMC of 2 million. Data stratified by TMC and patient parameters can be used to counsel patients pursuing ART.

Keywords: IUI; Infertility; Intrauterine insemination; Total motile sperm count.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Clinical pregnancy rate by pre-wash total motile count and maternal age, AMH, stimulation regimen and infertility diagnosis. TMC, total motile count; AMH, anti-Mullerian hormone; DOR, diminished ovarian reserve
Fig. 2
Fig. 2
Frequency of patients and clinical pregnancies by pre-wash total motile count
See this image and copyright information in PMC

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