23cd071dbf2e4b44bbb04ca48a802637 pmc_10179676.pdf 4c698c505bbd673df446d51ef1aeeeee0b4532b0 pmc_10179676.pdf 2be6d2c054535a565d08a9d51ed4cb5f8b6af3bbfd50f5d8b3419ac29b6e11a9 pmc_10179676.pdf Title: An Algorithm to Predict the Lack of Pregnancy after Intrauterine Insemination in Infertile Patients Subject: Increasing intrauterine insemination (IUI) success rates is essential to improve the quality of care for infertile couples. Additionally, straight referral of couples with less probability of achieving a pregnancy through IUI to more complex methods such as in vitro fertilization is important to reduce costs and the time to pregnancy. The aim of the present study is to prospectively evaluate the threshold values for different parameters related to success in intrauterine insemination in order to provide better reproductive counseling to infertile couples, moreover, to generate an algorithm based on male and female parameters to predict whether the couple is suitable for achieving pregnancy using IUI. For that, one hundred ninety-seven infertile couples undergoing 409 consecutive cycles of intrauterine insemination during a two-year period were included. The first year served as a definition of the parameters and thresholds related to pregnancy achievement, while the second year was used to validate the consistency of these parameters. Subsequently, those parameters that remained consistent throughout two years were included in a generalized estimating equation model (GEE) to determine their significance in predicting pregnancy achievement. Parameters significantly associated with the lack of pregnancy through IUI and included in the GEE were (p < 0.05): (i) male age > 41 years; (ii) ejaculate sperm count < 51.79 106 sperm; (iii) swim-up alkaline Comet > 59%; (iv) female body mass index > 45 kg/m2; (v) duration of infertility (>84 months), and (vi) basal LH levels > 27.28 mUI/mL. The application of these limits could provide a pregnancy prognosis to couples before undergoing intrauterine insemination, therefore avoiding it in couples with low chances of success. The retrospective application of these parameters to the same cohort of patients would have increased the pregnancy rate by up to 30%. Keywords: intrauterine insemination; pregnancy; prognosis; Comet assay Author: Emma Garcia-Grau, Mario Oliveira, Maria José Amengual, Encarna Rodriguez-Sanchez, Ana Veraguas-Imbernon, Laura Costa, Jordi Benet and Jordi Ribas-Maynou Creator: LaTeX with hyperref Producer: pdfTeX-1.40.21 CreationDate: Thu May 4 07:52:33 2023 CEST ModDate: Thu May 4 07:54:28 2023 CEST Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 13 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 305522 bytes Optimized: no PDF version: 1.7 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- LWJOET+VnURWPalladioL Type 1 Custom yes yes no 10 0 CDINEI+URWPalladioL-Bold Type 1 Custom yes yes no 15 0 ZJKOUF+URWPalladioL-Roma Type 1 Custom yes yes no 20 0 PUYPTK+URWPalladioL-Ital Type 1 Custom yes yes no 24 0 DYUFJK+CMSY10 Type 1 Builtin yes yes no 28 0 BTFGED+VnURWPalladioL-Bold Type 1 Custom yes yes no 32 0 XPUSBJ+TimesNewRomanPS-BoldItalicMT Type 1C WinAnsi yes yes no 50 0 BSDWLC+TimesNewRomanPSMT Type 1C WinAnsi yes yes no 53 0 OVNEXW+EURM10 Type 1 Builtin yes yes no 78 0 Jhove (Rel. 1.28.0, 2023-05-18) Date: 2024-02-02 02:34:58 CET RepresentationInformation: pmc_10179676.pdf ReportingModule: PDF-hul, Rel. 1.12.4 (2023-03-16) LastModified: 2023-09-08 02:19:16 CEST Size: 305522 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 296 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Introduction Destination: section.1 Item: Title: Material and Methods Destination: section.2 Children: Item: Title: Sample Size and Study Design Destination: subsection.2.1 Item: Title: Patient Selection and Study Variables Destination: subsection.2.2 Item: Title: Semen Sample Collection Destination: subsection.2.3 Item: Title: Swim-Up Procedure Destination: subsection.2.4 Item: Title: Alkaline and Neutral Comet Assay Destination: subsection.2.5 Item: Title: Intrauterine Insemination Destination: subsection.2.6 Item: Title: Data Analysis Procedure and Statistical Analysis Destination: subsection.2.7 Item: Title: Results Destination: section.3 Children: Item: Title: Clinical Features and Pregnancy Rates Obtained in Our Cohort Destination: subsection.3.1 Item: Title: Male Parameters That were Found to Be Associated with Lack of Pregnancy in IUI Couples Destination: subsection.3.2 Item: Title: Female Parameters That were Found to Be Associated with Lack of Pregnancy in IUI Couples Destination: subsection.3.3 Item: Title: Generalized Estimating Equation (GEE) Modeling Destination: subsection.3.4 Item: Title: Discussion Destination: section.4 Item: Title: Conclusions Destination: section.5 Item: Title: References Destination: section.6 Info: Title: An Algorithm to Predict the Lack of Pregnancy after Intrauterine Insemination in Infertile Patients Author: Emma Garcia-Grau, Mario Oliveira, Maria José Amengual, Encarna Rodriguez-Sanchez, Ana Veraguas-Imbernon, Laura Costa, Jordi Benet and Jordi Ribas-Maynou Subject: Increasing intrauterine insemination (IUI) success rates is essential to improve the quality of care for infertile couples. Additionally, straight referral of couples with less probability of achieving a pregnancy through IUI to more complex methods such as in vitro fertilization is important to reduce costs and the time to pregnancy. The aim of the present study is to prospectively evaluate the threshold values for different parameters related to success in intrauterine insemination in order to provide better reproductive counseling to infertile couples, moreover, to generate an algorithm based on male and female parameters to predict whether the couple is suitable for achieving pregnancy using IUI. For that, one hundred ninety-seven infertile couples undergoing 409 consecutive cycles of intrauterine insemination during a two-year period were included. The first year served as a definition of the parameters and thresholds related to pregnancy achievement, while the second year was used to validate the consistency of these parameters. Subsequently, those parameters that remained consistent throughout two years were included in a generalized estimating equation model (GEE) to determine their significance in predicting pregnancy achievement. Parameters significantly associated with the lack of pregnancy through IUI and included in the GEE were (p < 0.05): (i) male age > 41 years; (ii) ejaculate sperm count < 51.79 106 sperm; (iii) swim-up alkaline Comet > 59%; (iv) female body mass index > 45 kg/m2; (v) duration of infertility (>84 months), and (vi) basal LH levels > 27.28 mUI/mL. The application of these limits could provide a pregnancy prognosis to couples before undergoing intrauterine insemination, therefore avoiding it in couples with low chances of success. The retrospective application of these parameters to the same cohort of patients would have increased the pregnancy rate by up to 30%. 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