title: Effect of clinical and semen characteristics on efficacy of ovulatory stimulation in patients undergoing intrauterine insemination.
abstract: OBJECTIVE
  We measured the effect of ovulatory stimulation (OS) upon intrauterine insemination (IUI) success rates, particularly among patients with risk factors for IUI failure.
  
  
  METHODS
  Retrospective review of medical and laboratory results from 512 patients who underwent 1576 cycles of IUI with partner's sperm over a 3 year period. Data were collected on 3 risk factors for IUI failure (advanced female age > 37.7 years, prior corrective pelvic surgery, and poor post-wash sperm motility), and on method of OS (none, clomiphene citrate, or gonadotropin).
  
  
  RESULTS
  Patients who underwent OS had significantly higher pregnancy rates (7.6%) than those who did not (4.7%, p = 0.02). However, when patients were stratified by their risk factors, OS made a significant difference only for patients without risk factors. These patients had a 15.5% per cycle pregnancy rate with OS, compared to 7.9% in unstimulated IUI cycles (p = 0.04).
  
  
  CONCLUSIONS
  Ovulatory stimulation doubles IUI pregnancy rates among young patients without a prior pelvic surgery and with good post-wash semen quality. The benefit of OS for patients with risk factors for IUI failure is unclear. These patients should be counseled that their chances for success with IUI are limited, with or without OS.
authors.affiliation: Andrology Research Laboratory, Cleveland Clinic Foundation, Ohio 44195, USA.
authors.forename: B N
authors.initials: BN
authors.lastname: Hendin
authors.forename: T
authors.initials: T
authors.lastname: Falcone
authors.forename: J
authors.initials: J
authors.lastname: Hallak
authors.forename: J
authors.initials: J
authors.lastname: Goldberg
authors.forename: A J
authors.initials: AJ
authors.lastname: Thomas
authors.forename: D R
authors.initials: DR
authors.lastname: Nelson
authors.forename: A
authors.initials: A
authors.lastname: Agarwal
mesh_terms: D000328:Adult; D000367:Age Factors; D002996:Clomiphene / Q000008:administration & dosage / Q000627:therapeutic use; D003627:Data Interpretation, Statistical; D005260:Female; D005300:Fertility Agents, Female / Q000008:administration & dosage / Q000627:therapeutic use; D006062:Gonadotropins / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D007315:Insemination, Artificial / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010060:Ovulation; D010062:Ovulation Induction; D011247:Pregnancy; D018873:Pregnancy Rate; D012189:Retrospective Studies; D012661:Semen / Q000166:cytology / Q000502:physiology*; D013081:Sperm Motility; D014599:Uterus
chemical_list: D005300:Fertility Agents, Female; D006062:Gonadotropins; D002996:Clomiphene