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Prognostic scoring index for intrauterine insemination success among Filipino couple

Gladys Anne M. Bermio, MD; Brenda Bernadette B. Zamora, MD, FPOGS, FPSMFM
Department of Obstetrics and Gynecology, St. Luke’s Medical Center, Quezon City

Objectives: To identify the clinical factors associated with intrauterine insemination (IUI) success among Filipino couples and incorporate the significant clinical factors in a formula for a prognostic scoring index for the success of IUI.

Methods: This is a review of cases who consulted for infertility and underwent IUI at a tertiary hospital between January 2007 and December 2014. The variables considered for analysis were female age, duration of infertility, etiology of infertility, method of sperm processing, number of preovulatory follicles, total motile insemination count (TMSC), and sperm motility. The outcome measure was determined either by a positive urine or serum beta HCG or a gestational sac on transvaginal ultrasound. Results from the logistic regression analysis were used to develop prognostic scoring index for IUI success. Computed scores were plotted in a Receiver Operating Characteristic Curve and cut off values were determined.

Results: The overall pregnancy rate in this study was 10.7%. Duration of infertility (OR 10.33, 95% CI 3.488-30.602) and sperm motility (OR 5.30, 95% CI 1.830-15.331) showed the strongest significant association with the occurrence of pregnancy. Odds of pregnancy after IUI are likewise increased in female age of < 32.5 years (OR 2.52, 95% CI 1.704-3.734), swim-up method (OR 2.17, 95% CI 1.383-3.415) and TMSC of >19.5 million (OR 1.78, 95% CI 1.076-2.954). The odds of successful pregnancy among patients whose duration of infertility is < 2.5 years and who have a sperm motility count of > 67.5 are more than thrice (OR 3.13, 95% CI 0.095-0.990), compared to those with duration of infertility of > 2.5 years. The formulated prognostic scoring index for IUI success was 18.6, with specificity of 91.1%, sensitivity of 39.4%.

Conclusion: Duration of infertility, female age, sperm motility, TMSC and sperm processing method significantly affect the success of IUI success among Filipino couples studied. Using the formula derived, with a sensitivity of 91% and a sensitivity of 39, couples with a score of >18.6 are more likely to get pregnant 4 times more than those with a score of less than 18.6.