Abstract
Research question
Can an optimal LH threshold algorithm accurately predict timing of ovulation for natural cycle–intrauterine insemination (NC-IUI)?
Design
A retrospective cohort study (2018–2022) including 2467 natural cycles. Ovulation timing for these cycles was determined using a previously developed AI model. Two LH thresholds, low and high, were determined in the LH algorithm. Being below the low threshold meant that ovulation is likely to occur in ≥ 4 days, suggesting another daily blood test. Between the two thresholds meant that ovulation was likely in 2–3 days, suggesting IUI the next day. Above the high threshold meant that ovulation will likely occur tomorrow, suggesting performing IUI on the same day.
Results
The optimal LH model with a high threshold of 40 mIU/ml and a low threshold of 11 mIU/ml succeeded in correctly predicting timing for IUI (day − 1, − 2 relative to ovulation) in 75.4% (95%CI 75.3–75.4). In 23.1% (95%CI 23.0–23.2), the algorithm predicted “error,” suggesting performing insemination when in fact it would have been performed on a non-optimal day (0 or − 3). A previously described 3-hormone-based (LH, estradiol, progesterone) AI model performed significantly better in all parameters (93.6% success rate, 4.3 “error” rate).
Conclusions
An LH threshold model, representing common practice, evaluating all possible high and low LH threshold combinations, was successful in accurately scheduling timing for IUI in only 75% of cases. Integrating all three hormones as performed in the AI model may have an advantage in accurately predicting the optimal time for IUI, over the use of LH only.
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Data availability
The data that support the findings of this study are not openly available due to reasons of sensitivity and are available from the corresponding author upon reasonable request.
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Funding
This study was funded by FertilAI, Israel.
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A.H, R.H, A.L, E.M, and M.Y designed the study, A.H, E.M, M.B, R.H, E.M, T.B.B, and A.L contributed to the data collection, M.Y, A.H, A.L, and E.M drafted the first version of the manuscript, A.L, S.R, A.H, R.H, and M.Y contributed to data analysis and interpretation. All authors revised the manuscript and approved the final submitted version.
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A.H, E.M, R.H, A.L, and M.B are shareholders and board members of FertilAI LTD. S.R and E.M are employees of FertilAI LTD. M.Y and T.B.B report no conflict of interest.
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Youngster, M., Moran, E., Luz, A. et al. Intrauterine insemination timing models—LH can only take you so far. J Assist Reprod Genet (2024). https://doi.org/10.1007/s10815-024-03135-4
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DOI: https://doi.org/10.1007/s10815-024-03135-4