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      Análisis Preliminar de Factores que Influencian las Tazas de Embarazo en Inseminación Intrauterina en la Clínica CIES Translated title: Preliminary Analysis of Factors Influencing Pregnancy Rates in Intrauterine Insemination at CIES Clinic

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          Abstract

          La inseminación intrauterina es una de las modalidades terapéuticas más comúnmente empleadas en fertilidad. Sin embargo, utilizando esta técnica la tasa de embarazo está sujeta a muchas variables. En este análisis preliminar se consideran diferentes variables con el objetivo de determinar posibles factores predictivos de la tasa de embarazo. Se analizaron las variables de edad de la mujer, numero de folículos pre-ovulatorios, tamaño de folículo dominante, grosor del endometrio y conteo espermático de espermatozoides grado A, que según estudios son los más importantes en Inseminación Intrauterina. Los resultados mostraron que nuestra tasa de embarazo general por ciclo fue de 7,1% y no se registraron embarazos múltiples. La mayor tasa de embarazo por ciclo se observó entre las parejas con un conteo de espermatozoides progresivos rápidos [PRR] mayor a 20,1 x 106 [25%] después de la preparación de capacitación, con una edad de la mujer entre 35-39 años [11,1%] y 40-42 años [14,3%] y un grosor de endometrio entre 8,1 y 10 mm [13%]. En conclusión, observamos que la tasa de embarazo es mayor cuando es mayor el tamaño de folículo dominante [>20mm], el grosor del endometrio es mayor a 8mm y el número de espermatozoides progresivos grado A es mayor a 20 millones.

          Translated abstract

          Intrauterine Insemination is one of the most commonly used therapeutic modalities in fertility. Nevertheless, the pregnancy rate using this technique is related to many variables. In this preliminary analysis it was considered different variables in order to determinate predictors of pregnancy rate. Those variables were female age, number of pre-ovulatory follicles, dominant follicle size, thickness of the endometrium and sperm count of grade A sperms, which according to studies are the most important variables for intrauterine insemination. The results showed that our overall pregnancy rate per cycle was 7.5% and no multiple pregnancies were recorded.The high pregnancy rate per cycle was observed between couples with a progressive motility spermatozoa [PR] count above 20.1x106 [25%] after sperm preparation techniques, with a women age of 35 - 39 years old [11.1%] and 39-42 years old [14.3%] and an endometrial thickness between 8.1-10 mm [13%]. In conclusion, we observed that the pregnancy rate is greatest when the size of dominant follicle is larger [>20mm], endometrial thickness is more than 8mm and the number of progressive spermatozoa grade A is more than 20 million.

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          Intrauterine insemination treatment in subfertility: an analysis of factors affecting outcome.

          A total of 811 intrauterine insemination (IUI) cycles in which clomiphene citrate/human menopausal gonadotrophin (HMG) was used for ovarian stimulation were analysed retrospectively to identify prognostic factors regarding treatment outcome. The overall pregnancy rate was 12.6% per cycle, the multiple pregnancy rate 13.7%, and the miscarriage rate 23.5%. Logistic regression analysis revealed five predictive variables as regards pregnancy: number of the treatment cycle (P = 0.009), duration of infertility (P = 0.017), age (P = 0.028), number of follicles (P = 0.031) and infertility aetiology (P = 0.045). The odds ratios for age < 40 years, unexplained infertility aetiology (versus endometriosis) and duration of infertility < or = 6 years were 3.24, 2.79 and 2.33, respectively. A multifollicular ovarian response to clomiphene citrate/HMG resulted in better treatment success than a monofollicular response, and 97% of the pregnancies were obtained in the first four treatment cycles. The results indicate that clomiphene citrate/HMG/IUI is a useful and cost-effective treatment option in women < 40 years of age with infertility duration < or = 6 years, who do not suffer from endometriosis.
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            The effectiveness of ovulation induction and intrauterine insemination in the treatment of persistent infertility: a meta-analysis.

            A systematic review was conducted to evaluate the effectiveness of intrauterine insemination (IUI) with or without ovarian stimulation using gonadotrophin in the treatment of persistent infertility. Relevant randomized controlled trials were identified by a diverse strategy including a hand search of 43 core journals from 1966 to the present. Two approaches to meta-analysis were used to summarize data. First, using a standard Mantel-Haenszel approach, eight trials comparing FSH/IUI with FSH/timed intercourse for unexplained infertility were combined. The common odds ratio for pregnancy was 2.37 [95% confidence interval (CI), 1.43, 3.90], suggesting a significant improvement with IUI following ovulation induction in this patient group. Although the data were statistically homogeneous, clinically important heterogeneity was present. Second, across all diagnostic groups, the independent effects of treatment with follicle stimulating hormone (FSH), clomiphene citrate, IUI, as well as the diagnoses of male factor and endometriosis were assessed using stepwise logistic regression. Based on 5214 cycles reported in 22 trials, the odds ratio for pregnancy associated with FSH use was 2.35 (95% CI, 1.87, 2.94) for IUI, 2.82 (95% CI, 2.18, 3.66) for male factor, 0.48 (95% CI, 0.37, 0.61), and for endometriosis 0.45 (95% CI, 0.27, 0.76). This summary of the best available evidence may prove useful in counselling couples who are considering FSH and/or IUI therapy.
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              Analysis of factors influencing pregnancy rates in homologous intrauterine insemination.

              To identify predictors of pregnancy rate (PR) among women undergoing homologous IUI. Cross-sectional analysis of IUI cycles carried out from January 2000 to September 2002. Private infertility center in Alicante, Spain. Four hundred seventy women undergoing 1,010 cycles of IUI. Single IUI with ovarian stimulation using hMG. Preovulatory follicles (>15 mm), motile spermatozoa count, type and duration of infertility, female age, insemination timing, and cycle number. Overall PR per cycle and multiple pregnancy and miscarriage rates were 9.2%, 8.6%, and 11.8%, respectively. Three significant predictors of pregnancy were identified by multiple logistic regression analysis: preovulatory follicles, spermatozoa count, and infertility duration. Interuterine insemination with three follicles almost tripled the PR with respect to only one, odds ratio (OR) = 2.89 (95% confidence interval [CI], 1.54-5.41). Compared with insemination with a motile sperm count >30 x, 20.1-30, 10.1-20, 5.1-10, and or =3 years was marginally associated with a lower PR, OR = 0.65 (95% CI, 0.40-1.04). Overall, female age was not a significant predictor of pregnancy, and although PR slightly decreased beyond two IUI cycles and when a single IUI was performed 36-40 hours after hCG administration, results were not statistically significant. Homologous IUI achieves the best results with two or three induced follicles, a high motile spermatozoa count, and infertility duration <3 years, irrespective of female age and fertility history.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                rccm
                Revista Científica Ciencia Médica
                Rev Cient Cienc Méd
                Facultad de Medicina, Universidad Mayor de San Simón. (Cochabamba, Cochabamba, Bolivia )
                2077-3323
                2014
                : 17
                : 2
                : 23-27
                Affiliations
                [02] La Paz orgnameCentro de Fertilidad CIES orgdiv1Área de ginecología Bolivia
                [01] orgnameCentro de Fertilidad CIES orgdiv1Andrología y Embriología romerovalenzuela@ 123456yahoo.es
                [03] orgnameCentro de Fertilidad CIES
                Article
                S1817-74332014000200006
                b92a282a-ef8a-4442-8459-59b55447e683

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                : 05 November 2014
                : 23 October 2014
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 24, Pages: 5
                Product

                SciELO Bolivia


                Inseminación Intrauterina,Tasa de Embarazo,Pronóstico,Intrauterine Insemination,Pregnancy Rate,Prognosis

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