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- Title
Intrauterine insemination cycles: prediction of success and thresholds for poor prognosis and futile care.
- Authors
Ainsworth, Alessandra J.; Barnard, Emily P.; Baumgarten, Sarah C.; Weaver, Amy L.; Khan, Zaraq
- 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.
- Subjects
GENERALIZED estimating equations; NOMOGRAPHY (Mathematics); FORECASTING; INDUCED ovulation; PROGNOSIS; BIRTH rate; ORAL drug administration
- Publication
Journal of Assisted Reproduction & Genetics, 2020, Vol 37, Issue 10, p2435
- ISSN
1058-0468
- Publication type
Article
- DOI
10.1007/s10815-020-01918-z