title: Effect of diagnosis, age, sperm quality, and number of preovulatory follicles on the outcome of multiple cycles of clomiphene citrate-intrauterine insemination.
abstract: 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.
authors.affiliation: The Fertility Institute of New Orleans, New Orleans, Louisiana 70128, USA. info@fertilityinstitute.com
authors.forename: Richard P
authors.initials: RP
authors.lastname: Dickey
authors.forename: Steven N
authors.initials: SN
authors.lastname: Taylor
authors.forename: Peter Y
authors.initials: PY
authors.lastname: Lu
authors.forename: Belinda M
authors.initials: BM
authors.lastname: Sartor
authors.forename: Phillip H
authors.initials: PH
authors.lastname: Rye
authors.forename: Roman
authors.initials: R
authors.lastname: Pyrzak
mesh_terms: 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
chemical_list: D002996:Clomiphene