Erhan ATEŞ, Abdullah AKDAĞ, Arif KOL, Özgür Deniz TURAN, Haluk EROL

Bir üniversite hastanesi’nin intrauterin inseminasyon deneyimi: Gebelik oranı ve ilişkili faktörler

AMAÇ: İntrauterin inseminasyon (IUI) diğer yardımcı üreme tekniklerine göre daha ucuz, kolay uygulanabilir ve daha az invazif olması nedeniyle ilk seçenek tedavi yöntemi olarak kabul edilmektedir. Bu çalışmada bir üniversite hastanesi infertilite ünitesinde IUI sonuçlarının değerlendirilmesi ve başarıyı etkileyen erkek faktörlerinin ortaya konulması amaçlandı.GEREÇ ve YÖNTEMLER: Ekim 2017-Ocak 2020 tarihleri arasında infertilite ünitesine başvuran ve IUI yapılan çiftlerin verileri retrospektif olarak değerlendirildi. Hastaların yaş, başlangıç total sperm sayısı ve progresif motil sperm yüzdesi, yıkama sonrası total motil sperm sayısı (TMSC) ve yüzdesi gibi semen verileri kaydedildi. Dansite gradient yöntemiyle hazırlanan spermler ile tek inseminasyon sonrası ß-hCG testi pozitif olup transvajinal ultrasonografi (USG) ile gebeliği konfirme edilen hastalar gebe olarak kabul edildi ve IUI başarı kriteri olarak değerlendirildi. Semen parametreleri ile gebelik başarısı arasında ilişki uygun istatistiki yöntemlerle değerlendirildi.BULGULAR: Klinik gebelik oranı IUI uygulanan 146 çiftte %19,2, erkeğin verileri tam olan 136 çiftte ise %19,9 olup 136 erkeğin yaş ortalaması 30,34±5,94 yıl idi. Yaş ile IUI başarısı arasında istatistiksel olarak anlamlı ilişki saptanmamakla birlikte yaş arttıkça başarı şansının düştüğü görüldü (p=0,316). Semen volümü (p=0,228), yıkama öncesi TMSC (p=0,187), yıkama öncesi progresif motil sperm sayısı (p=0,128) ile gebelik oranları arasında istatistiksel olarak anlamlı bir ilişki saptanmadı. Yıkama sonrası progresif motil sperm yüzdesi arttıkça gebelik şansı istatistiksel olarak anlamlı bir şekilde arttığı görüldü (p=0,04), ancak yıkama sonrası TMSC ile bu ilişki saptanmadı (p=0,143). Başlangıç progresif motil sperm sayısı yüksekliği ile yıkama sonrası sperm sayısı arasında korelasyon saptandı (r: 0,286, p

Intrauterine insemination experience of a university hospital: Pregnancy rate and associated factors

OBJECTIVE: Intrauterine insemination (IUI) is considered as the first choice treatment method because it is cheaper, easily applicable and less invasive compared to other assisted reproductive techniques. The specific objective of this study was to evaluate the IUI results and to reveal the male factors affecting success in a university hospital infertility unit. MATRERIAL and METHODS: The data of the couples who applied to the infertility unit between October 2017 and January 2020 and underwent IUI were retrospectively evaluated. Semen analysis results such as initial total sperm count, progressive motile sperm percentage, post-washing TMSC and percentage, and ages of patients were recorded. To identify IUI success the following parameters were used: Patients whose ß-hCG test was positive after single insemination with sperm prepared by density gradient centrifugation and whose pregnancy was confirmed by transvaginal USG. Relationship between semen parameters and pregnancy success rates was evaluated using appropriate statistical methods. RESULTS: Clinical pregnancy rate was 19.2% in 146 couples who underwent IUI, 19.9% in 136 couples whose data were complete. Mean age of 136 men was 30.34±5.94 years. Although there was no significant relationship between age and IUI success, it was observed that the success rate decreased as age increased (p=0.316). No statistically significant correlation was found between semen volume (p=0.228), TMSC before washing (p=0.187), progressive motile sperm before washing (p=0.128) and pregnancy rates. It was observed that as the percentage of progressive motile sperm after washing increased, the pregnancy rate increased significantly (p=0.04), but this relationship was not found with the total motile sperm count after washing (p=0.143). There was a correlation between initial progressive motile sperm count and sperm count after washing (r: 0.286, p

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1. Moghissi KS, Wallach EE. Unexplained infertility. Fertil Steril 1983;39:5–21. [CrossRef]
2. Guzick DS, Grefenstette I, Baffone K, Berga SL, Krasnow JS, Stovall DW, Naus GJ. Infertility evaluation in fertile women: a model for assessing the efficacy of infertility testing. Hum Reprod 1994;9:2306–10. [CrossRef]
3. Garceau L, Henderson J, Davis LJ, Petrou S, Henderson LR, McVeigh E, et al. Economic implications of assisted reproductive techniques: a systematic review. Hum Reprod 2002;17:3090–109. [CrossRef]
4. Zegers-Hochschild F, Nygren KG, Adamson GD, de Mouzon J, Lancaster P, Mansour R, Sullivan E. International Committee Monitoring Assisted Reproductive Technologies. The ICMART glossary on ART terminology. Hum Reprod 2006;21:1968–70. [CrossRef]
5. Bai F, Wang DY, Fan YJ, Qiu J, Wang L, Dai Y, Song L. Assisted reproductive technology service availability, efficacy and safety in mainland China:2016. Hum Reprod 2020;35:446–52. [CrossRef]
6. Dickey RP, Pyrzak R, Lu PY, Taylor SN, Rye PH. Comparison of the sperm quality necessary for successful intrauterine insemination with World Health Organization threshold values for normal sperm. Fertil Steril 1999;71:684–9. [CrossRef]
7. Sakhel K, Schwarck S, Ashraf M, Abuzeid M. Semen parameters as determinants of success in 1662 cycles of intrauterine insemination after controlled ovarian hyperstimulation. Fertil Steril 2005;84:248–9. [CrossRef]
8. Karabinus DS, Gelety TJ. The impact of sperm morphology evaluated by strict criteria on intrauterine insemination success. Fertil Steril 1997;67:536–41. [CrossRef]
9. Wainer R, Albert M, Dorion A, Bailly M, Bergère M, Lombroso R, et al. Influence of the number of motile spermatozoa inseminated and of their morphology on the success of intrauterine insemination. Hum Reprod 2004;19:2060–5. [CrossRef]
10. Miller DC, Hollenbeck BK, Smith GD, Randolph JF, Christman GM, Smith YR, et al. Processed total motile sperm count correlates with pregnancy outcome after intrauterine insemination. Urology 2002;60:497–501. [CrossRef]
11. Papillon-Smith J, Baker SE, Agbo C, Dahan MH. Pregnancy rates with intrauterine insemination: comparing 1999 and 2010 World Health Organization semen analysis norms. Reprod Biomed Online 2015;30:392–400. [CrossRef]
12. Van Voorhis BJ, Barnett M, Sparks AE, Syrop CH, Rosenthal G, Dawson J. Effect of the total motile sperm count on the efficacy and cost-effectiveness of intrauterine insemination and in vitro fertilization. Fertil Steril 2001;75:661–8. [CrossRef]
13. Ombelet W, Dhont N, Thijssen A, Bosmans E, Kruger T. Semen quality and prediction of IUI success in male subfertility: a systematic review. ReprodBiomed Online 2014;28:300–9. [CrossRef]
14. Tomlinson MJ, Amissah-Arthur JB, Thompson KA, Kasraie JL, Bentick B. Prognostic indicators for intrauterine insemination (IUI): statistical model for IUI success. Hum Reprod 1996;11:1892–6. [CrossRef]
15. O’Flaherty C, Lamirande E, Gagnon C. Positive role of reactive oxygen species in mammalian sperm capacitation: triggering and modulation of phosphorylation events. Free Radic Biol Med 2006;41:528–40. [CrossRef]
16. Agarwal A, Saleh RA, Bedaiwy MA. Role of reactive oxygen species in the pathophysiology of human reproduction. Fertil Steril 2003;79:829–43. [CrossRef]
17. Van Waart J, Kruger TF, Lombard CJ, Ombelet W. Predictive value of normal sperm morphology in intrauterine insemination (IUI): a structured literature review. Hum Reprod Update 2001;7:495– 500. [CrossRef]
18. Hauser R, Yogev L, Botchan A, Lessing JB, Paz G, Yavetz H. Intrauterine insemination in male factor subfertility: significance of sperm motility and morphology assessed by strict criteria. Andrologia 2001;33:13–7. [CrossRef]
19. Van Weert JM, Repping S, Van Voorhis BJ, van der Veen F, Bossuyt PM, Mol BWJ. Performance of the postwash total motile sperm count as a predictor of pregnancy at the time of intrauterine insemination: a meta-analysis. Fertil Steril 2004;82:612–20. [CrossRef]
20. Berg U, Brucker C, Berg FD. Effect of motile sperm count after swim-up on outcome of intrauterine insemination. Fertil Steril 1997;67:747–50. [CrossRef]
21. Wainer R, Merlet F, Bailly M, Lombroso R, Camus E, Bisson JP. Prognosis for intrauterine insemination with partner’s sperm according to the characteristics of the spermatozoa. Contracept Fertil Sex 1996;24:897–903.
22. Huang HY, Lee CL, Lai YM, Chang MY, Wang HS, Chang SY, Soong YK. The impact of the total motile sperm count on the success of intrauterine insemination with husband’s spermatozoa. J Assist Reprod Genet 1996;13:56–63. [CrossRef]
23. Kılıçdağ EB, Bağış T, Haydardedeoğlu B, Tarım E, Aslan E, Erkanlı S, et al. İntrauterin İnseminasyon (Iuı) Sikluslarında Gebelik Sonuçlarını Etkileyebilecek Prognostik Faktörler. Turk J Obstet Gynecol 2005;2:223–8. http://cms.galenos.com.tr/Uploads/ Article_9358/223-228.pdf
24. Brasch JG, Rawlins R, Tarchala S, Radwanska E. The relationship between total motile sperm count and the success of intrauterine insemination. Fertil Steril 1994;62:150–4. [CrossRef]
25. Terada Y, Fukaya T, Haraya H, Yajima A. Sperm motility characteristics and pregnancy outcome of artificial insemination with husband’s semen formale infertility. Tohoku J Exp Med 1995;177:337–41. [CrossRef]
26. Milingos S, Comhaire FH, Liapi A, Aravantinos D. The value of semen characteristics and tests of sperm function in selecting couples for intrauterine insemination. Eur J Obstet Gynecol Reprod Biol 1996;64:115–8. [CrossRef]
27. Zhao Y, Vlahos N, Wyncott D, Petrella C, Garcia J, Zacur H, Wallach EE. Impact of semen characteristics on the success of intrauterine insemination. J Assist Reprod Genet 2004;21:143–8. [CrossRef]
28. Hendin BN, Falcone T, Hallak J, Nelson DR, Vemullapalli S, Goldberg J, et al. The effect of patient and semen characteristics on live birth rates following intrauterine insemination: a retrospective study. J Assist Reprod Genet 2000;17:245–52. [CrossRef]