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Background: Some studies have stated that intrauterine insemination (IUI) with controlled ovarian stimulation (COS) might increase the pregnancy rate, while others suggest that IUI in the natural cycle (NC) should be the first line of treatment. It remains unclear whether it is necessary to use COS at the same time when IUI is applied to treat isolated male factor infertility. Thus, we aimed to investigate efficacy of IUI with COS for isolated male factor infertility.
Methods: A total of 601 IUI cycles from 307 couples who sought medical care for isolated male factor infertility between January 2010 and February 2020 were divided into two groups: NC-IUI and COS-IUI. The COS-IUI group was further divided into two subgroups according to the number of pre-ovulatory follicles on the day of HCG: cycles with monofollicular development (one follicle group) and cycles with at least two pre-ovulatory follicles (≥ 2 follicles group). The IUI outcomes, including clinical pregnancy, live birth, spontaneous abortion, ectopic pregnancy, and multiple pregnancy rates were compared.
Results: The clinical pregnancy, live birth, spontaneous abortion, and ectopic pregnancy rates were comparable between the NC-IUI and COS-IUI group. Similar results were also observed among the NC-IUI, one follicle, and ≥ 2 follicles groups. However, with respect to the multiple pregnancy rate, a trend toward higher multiple pregnancy rate was observed in the COS-IUI group compared to the NC-IUI group (8.7% vs. 0, P=0.091), and a significant difference was found between the NC-IUI and ≥ 2 follicles group (0 vs. 16.7%, P=0.033).
Conclusion: In COS cycles, especially in those with at least two pre-ovulatory follicles, the multiple pregnancy rate increased without a substantial gain in overall pregnancy rate; thus, COS should not be preferred in IUI for isolated male factor infertility. If COS is required, one stimulated follicle and one healthy baby should be the goal considering the safety of both mothers and foetuses.
Keywords
Intra-uterine insemination, Controlled ovarian stimulation, Clinical pregnancy, Live birth, Multiple pregnancy
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CURRENT STATUS: Published
View the published article at Reproductive Biology and Endocrinology.
Version 2
Posted 04 Feb, 2021
No community comments so far
Editorial decision: Minor revision
On 20 Feb, 2021
Review #2 received
Received 17 Feb, 2021
Reviewer #3 agreed
On 14 Feb, 2021
Review #1 received
Received 14 Feb, 2021
Review #3 received
Received 14 Feb, 2021
Reviewer #2 agreed
On 12 Feb, 2021
Reviewers invited
Invitations sent on 11 Feb, 2021
Reviewer #1 agreed
On 11 Feb, 2021
Editor assigned
On 30 Jan, 2021
Submission checks complete
On 30 Jan, 2021
Editor invited
On 30 Jan, 2021
No comments provided
Editorial decision: Major revision
On 16 Dec, 2020
Review #3 received
Received 15 Dec, 2020
Reviewer #4 agreed
On 07 Dec, 2020
Review #2 received
Received 05 Dec, 2020
Reviewer #3 agreed
On 04 Dec, 2020
Reviewer #2 agreed
On 04 Dec, 2020
Review #1 received
Received 15 Nov, 2020
Reviewer #1 agreed
On 11 Nov, 2020
Reviewers invited
Invitations sent on 10 Nov, 2020
First submitted
On 31 Oct, 2020
Editor assigned
On 31 Oct, 2020
Submission checks complete
On 31 Oct, 2020
Editor invited
On 31 Oct, 2020
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PDF Downloads: ...
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Subject Areas
Endocrinology & Metabolism
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This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research
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This manuscript passed our Prescreen assessment
Complete author information
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Peer Review Timeline
CURRENT STATUS: Published
View the published article at Reproductive Biology and Endocrinology.
Version 2
Posted 04 Feb, 2021
No community comments so far
Editorial decision: Minor revision
On 20 Feb, 2021
Review #2 received
Received 17 Feb, 2021
Reviewer #3 agreed
On 14 Feb, 2021
Review #1 received
Received 14 Feb, 2021
Review #3 received
Received 14 Feb, 2021
Reviewer #2 agreed
On 12 Feb, 2021
Reviewers invited
Invitations sent on 11 Feb, 2021
Reviewer #1 agreed
On 11 Feb, 2021
Editor assigned
On 30 Jan, 2021
Submission checks complete
On 30 Jan, 2021
Editor invited
On 30 Jan, 2021
No comments provided
Editorial decision: Major revision
On 16 Dec, 2020
Review #3 received
Received 15 Dec, 2020
Reviewer #4 agreed
On 07 Dec, 2020
Review #2 received
Received 05 Dec, 2020
Reviewer #3 agreed
On 04 Dec, 2020
Reviewer #2 agreed
On 04 Dec, 2020
Review #1 received
Received 15 Nov, 2020
Reviewer #1 agreed
On 11 Nov, 2020
Reviewers invited
Invitations sent on 10 Nov, 2020
First submitted
On 31 Oct, 2020
Editor assigned
On 31 Oct, 2020
Submission checks complete
On 31 Oct, 2020
Editor invited
On 31 Oct, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Endocrinology & Metabolism
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at Reproductive Biology and Endocrinology.
Background: Some studies have stated that intrauterine insemination (IUI) with controlled ovarian stimulation (COS) might increase the pregnancy rate, while others suggest that IUI in the natural cycle (NC) should be the first line of treatment. It remains unclear whether it is necessary to use COS at the same time when IUI is applied to treat isolated male factor infertility. Thus, we aimed to investigate efficacy of IUI with COS for isolated male factor infertility.
Methods: A total of 601 IUI cycles from 307 couples who sought medical care for isolated male factor infertility between January 2010 and February 2020 were divided into two groups: NC-IUI and COS-IUI. The COS-IUI group was further divided into two subgroups according to the number of pre-ovulatory follicles on the day of HCG: cycles with monofollicular development (one follicle group) and cycles with at least two pre-ovulatory follicles (≥ 2 follicles group). The IUI outcomes, including clinical pregnancy, live birth, spontaneous abortion, ectopic pregnancy, and multiple pregnancy rates were compared.
Results: The clinical pregnancy, live birth, spontaneous abortion, and ectopic pregnancy rates were comparable between the NC-IUI and COS-IUI group. Similar results were also observed among the NC-IUI, one follicle, and ≥ 2 follicles groups. However, with respect to the multiple pregnancy rate, a trend toward higher multiple pregnancy rate was observed in the COS-IUI group compared to the NC-IUI group (8.7% vs. 0, P=0.091), and a significant difference was found between the NC-IUI and ≥ 2 follicles group (0 vs. 16.7%, P=0.033).
Conclusion: In COS cycles, especially in those with at least two pre-ovulatory follicles, the multiple pregnancy rate increased without a substantial gain in overall pregnancy rate; thus, COS should not be preferred in IUI for isolated male factor infertility. If COS is required, one stimulated follicle and one healthy baby should be the goal considering the safety of both mothers and foetuses.
Figure 1
This is a list of supplementary files associated with this preprint. Click to download.
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