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Intrauterine insemination cycles: prediction of success and thresholds for poor prognosis and futile care

Abstract

Purpose

We aimed to define intrauterine insemination (IUI) cycle characteristics associated with viable birth, identify thresholds below which IUI treatments are consistent with very poor prognosis and futile care, and develop a nomogram for individualized application.

Methods

This retrospective cohort study evaluated couples using fresh partner ejaculate for IUI from January 2005 to September 2017. Variables included female age, semen characteristics, and ovarian stimulation type. Using cycle-level data, we evaluated the association of these characteristics with the probability of viable birth by fitting generalized regression models for a binary outcome with a logit link function, using generalized estimating equation methodology to account for the correlation between cycles involving the same patient.

Results

The cohort consisted of 1117 women with 2912 IUI cycles; viable birth was achieved in 275 (9.4%) cycles. Futile care (viable birth rate < 1%) was identified for women age > 43, regardless of stimulation type or inseminate motility (IM). Very poor prognosis (viable birth rate < 5%) was identified for women using oral medications or Clomid plus gonadotropins who were (1) age < 35 with IM < 49%, (2) age 35–37 with IM < 56%, or (3) age ≥ 38, and (4) women age ≥ 38 using gonadotropins only with IM < 60%. A clinical prediction model and nomogram was developed with an optimism-corrected c-statistic of 0.611.

Conclusions

The present study highlights the impact of multiple clinical factors on IUI success, identifies criteria consistent with very poor prognosis and futile care, and provides a nomogram to individualize counseling regarding the probability of a viable birth.

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Availability of data and material

Data obtained from fertility database maintained in the Division of Reproductive Endocrinology and Infertility at Mayo Clinic.

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Correspondence to Zaraq Khan.

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The authors declare that they have no conflict of interest.

Ethics approval

Not required in this retrospective cohort study. The study was approved by Mayo Clinic IRB.

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Not applicable in retrospective cohort study.

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Not applicable in retrospective cohort study.

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Supplemental Figure 1

Results for the model used to derive the nomogram for the prediction of a viable birth based on cycle-level data: (a) histogram of the predicted probabilities of a viable and (b) calibration plot assessing the model performance. Observations were grouped into quintiles based on their predicted probabilities. The circles indicate the mean predicted probability for the quintile (x-axis) and the observed proportion with a viable birth in that quintile (y-axis). (PDF 4 kb)

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Ainsworth, A.J., Barnard, E.P., Baumgarten, S.C. et al. Intrauterine insemination cycles: prediction of success and thresholds for poor prognosis and futile care. J Assist Reprod Genet 37, 2435–2442 (2020). https://doi.org/10.1007/s10815-020-01918-z

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Keywords

  • Intrauterine insemination
  • Poor prognosis care
  • Futile care
  • Nomogram