Intrauterine Insemination Pregnancy Outcomes Related Influencing Factors

Objective: To investigate the factors influencing the pregnancy outcome of intrauterine insemination(IUI),to analyze the effects of the female age,the male age,the number of cycles,the duration of infertility,infertility types,the cause of infertility,treatment regimens,the timing of insemination on the pregnancy outcome,then discuss how to improve the success rate of IUI.Methods: From January 2007 to June 2017,a total of 26,473 IUI cycles of 12,165 couples in the clinical reproductive medicine center of jiangsu province hospital were retrospectively analyzed,including 19057 cycles of Artificial insemination with husband’s sperm(AIH)and 7,416 cycles of Artificial insemination by donor(AID),and the data comes from the Center’s CCRM database version 15.2.The relationship between the female age,the male age,the number of cycles,the duration of infertility,infertility types,the cause of infertility,treatment regimens,the timing of insemination and pregnancy outcomes was studied.Results: 1.In AIH,the clinical pregnancy rate(CPR)and live birth rate(LBR)were significantly reduced to 6.13%、4.16% in women aged 37 or older(P<0.001),and there was no pregnancy when their husbands aged 45 or older.After 3 AIH cycles,the cumulative clinical pregnancy rate(CCPR)and live birth rate(CLBR)were no longer significantly increased(P>0.05).If the woman is younger than 37,no matter the primary or secondary infertility,the LBR was significantly lower in patients with more than 5 years of infertility(8.03%、5.75%)than those less than 5 years(9.96%、10.91%,P<0.01).The live birth rate of ovulatory disorder and sexual dysfunction group(13.24%,17.66%)was significantly higher than that of mild oligospermia and asthenospermia(7.04%),tubal factor(6.62%),endometriosis (7.13%)and unexplained infertility(7.75%)(P=0.000).Clomiphene(CC)or letrozole(LE)combined with gonadotropin(Gn)could achieve higher LBR(12.20%、12.52%)than natural cycle(7.58%)or use CC/LE/HMG alone(8.14%,6.82%,7.82%,P<0.001).The LBR of pre-ovulation insemination in the stimulation cycle(10.29%)was higher than that of post-ovulation insemination(8.13%,P<0.05).2.In AID,infertility type,treatment regimen and the timing of insemination had no effect on pregnancy outcome(P>0.05);The abortion rate of women aged 37 or older increased to 37.5% significantly(P<0.001).After four AID cycles,the CCLR and CLBR were no longer significantly increased(P>0.05).The LBR of CC+Gn regimen were similar to that of LE+Gn regimen(21.04%,20.12%),but LE+Gn regimen significantly reduced multiple LBR(12.03%、4.80%,P<0.05).Conclusions: No matter AIH or AID,the female age is the most important factor influencing the pregnancy outcome.Furthermore,the influence of infertility duration,the male age and the cause of infertility on the pregnancy outcome must be considered simultaneously in AIH.LE+Gn regimen can significantly increase the LBR and diminish the risk of multiple pregnancy compared with CC+Gn.