P-054 Optimization of pregnancy rates in donor intrauterine insemination: impact of age, protocol, and number of cycles: analysis of 1961 cycles
Notice bibliographique
Résumé
Abstract Study question What are the factors optimizing pregnancy rates in donor intrauterine insemination (IUI) for the women who is not exposed to natural or spontaneous pregnancy? Summary answer Donor IUI is most effective for women under age 35, remains acceptable up to 42, and is optimized with natural cycles and ≤5 cycle attempts. What is known already Donor artificial insemination (AID) is widely used for single women and same-sex female couples. Maternal age, ovarian stimulation protocols, and the number of insemination cycles influence success rates. It is well established that pregnancy rates decrease with advancing maternal age due to diminished ovarian reserve and declining oocyte quality. Stimulation protocols are commonly employed to time ovulation, yet their effectiveness remains debated, particularly in older women. Limited data exist on the comparative benefits of natural versus stimulated cycles and the optimal number of insemination cycles required to achieve pregnancy. Study design, size, duration A retrospective observational study analyzed 745 women undergoing 1,961 donor IUI cycles between January 2023 and August 2024 at a university-affiliated fertility clinic in Montreal, Canada. The variables studied included age, protocol type, and the number of insemination attempts. The primary outcome was a positive pregnancy test. Participants/materials, setting, methods A total of 745 women undergoing 1,961 donor intra-uterine insemination cycles were categorized into five age groups (<35, 35–38, 38–40, 40–42, and ≥42 years). Cycle protocols were classified as natural or stimulated (letrozole, letrozole + gonadotropins, or gonadotropins alone). The study assessed pregnancy rates based on age, protocol type, and the number of insemination cycles performed. Main results and the role of chance A total of 1,961 cycles were analyzed, yielding 262 pregnancies. Pregnancy rates significantly declined with advancing age. For women <35 years (n = 1048), the pregnancy rate was 16.5%, which was significantly higher compared to women aged 35–38 years (11.2%, p = 0.01), 38–40 years (10.9%, p = 0.02), 40–42 years (7.4%, p = 0.006), and ≥42 years (3.4%, p = 0.001). No pregnancies were observed in women aged 43 or older. In ovarian stimulation methods, natural cycles (n = 570) showed a pregnancy rate of 15.4%, with a trend toward higher pregnancy rates compared to letrozole alone (n = 971, 12.8%), letrozole + Gonadotropins (n = 384, 11.9%), and Gonadotropins alone (n = 36, 11.1%). However, no statistically significant differences were found (p = 0.15, p = 0.12, p = 0.47, respectively). Most pregnancies (84%) occurred within the first four cycles, with 92% of pregnancies achieved by the fifth cycle (241/262). No statistically significant improvements in pregnancy rates were observed beyond five cycles (p = 0.22). Limitations, reasons for caution The retrospective study design and the reliance on positive pregnancy tests rather than live birth rates were the main limitations of our study. A randomized controlled study should be performed to confirm these findings. Wider implications of the findings Donor IUI is most effective under 35 and remains acceptable up to 42, with natural cycles reducing costs and risks without compromising outcomes. Success rates plateau after five cycles, suggesting an optimal limit. Detailed counseling is crucial for single women and same-sex couples to guide informed decisions on fertility treatments. Trial registration number No
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,001 | 0,002 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».