Effect of diagnosis, age, sperm quality, and number of preovulatory follicles on the outcome of multiple cycles of clomiphene citrate-intrauterine insemination.
OBJECTIVE
To determine how diagnosis, age, sperm quality, and number of preovulatory follicles affect pregnancy rates when multiple cycles of clomiphene citrate (CC)-IUI are performed.


METHODS
Fifteen-year prospective observational study.


METHODS
Private infertility clinic.


METHODS
Three thousand, three hundred eighty-one cycles of husband or donor IUI.


METHODS
Ovulation induction with CC and IUI.


METHODS
Per-cycle pregnancy rate (PR), cumulative pregnancy rate (CPR).


RESULTS
Pregnancy rates remained constant through four cycles, then fell significantly for diagnoses other than ovulatory dysfunction. Mean PRs for cycles 1-4 were significantly lower for patients with the following characteristics: age >/=43 years, poor semen quality, single preovulatory follicles, and diagnoses other than ovulatory dysfunction. Additional cycles of CC-IUI compensated for low PRs because of age, semen quality, or number of follicles. After four cycles, CPRs were 46% for ovulatory dysfunction; 38% for cervical factor, male factor, and unexplained infertility; 34% for endometriosis; and 26% for tubal factor. After six cycles, CPRs were 65% for ovulation dysfunction, 35% for endometriosis, and unchanged for other diagnoses.


CONCLUSIONS
Clomiphene citrate-intrauterine insemination should be performed for a minimum of four cycles. Additional cycles of CC-IUI can compensate for low pregnancy rates due to age, semen quality, or follicle number in patients with ovulation dysfunction.
Dickey
Richard P
RP
The Fertility Institute of New Orleans, New Orleans, Louisiana 70128, USA. info@fertilityinstitute.com
Taylor
Steven N
SN
Lu
Peter Y
PY
Sartor
Belinda M
BM
Rye
Phillip H
PH
Pyrzak
Roman
R
D000375:Aging / Q000502:physiology; D002996:Clomiphene / Q000627:therapeutic use*; D005260:Female; D005498:Follicular Phase; D006801:Humans; D007247:Infertility, Female / Q000209:etiology / Q000628:therapy*; D007248:Infertility, Male / Q000209:etiology / Q000628:therapy*; D007316:Insemination, Artificial, Heterologous; D007317:Insemination, Artificial, Homologous; D008297:Male; D006080:Ovarian Follicle / Q000503:physiopathology; D011247:Pregnancy; D018873:Pregnancy Rate; D011446:Prospective Studies; D013094:Spermatozoa / Q000502:physiology; D016896:Treatment Outcome
D002996:Clomiphene