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Federación Mexicana de Ginecología y Obstetricia, A.C.

2006, Número 12

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Ginecol Obstet Mex 2006; 74 (12)


Factores pronóstico de embarazo en inseminación intrauterina

Barros DJC, Rojas RJC, Molina MAC, Villalobos AS, Sánchez SV, Barroso VG, Gaviño GF

Idioma: Español
Referencias bibliográficas: 52
Paginas: 611-625
Archivo PDF: 474.24 Kb.


RESUMEN

Antecedentes: la inseminación artificial es una técnica que consiste en el depósito de espermatozoides en el conducto genital femenino sin contacto sexual y con la finalidad de lograr el embarazo. La inseminación intrauterina ha mejorado su tasa de éxito gracias a los avances tecnológicos y al mejor conocimiento de la fisiología reproductiva.
Objetivos: evaluar los factores pronósticos de éxito para el embarazo y calcular la tasa acumulada por ciclos en inseminación intrauterina.
Pacientes y métodos: se realizó un estudio descriptivo, retrospectivo, analítico y longitudinal. Se analizaron los ciclos de inseminación intrauterina del 1 enero del 2003 al 31 diciembre del 2005. Se incluyeron parejas con infertilidad primaria y secundaria de 24 a 41 años de edad. Se estimaron las variables de edad, tipo y tiempo de infertilidad, causas, densidad y movilidad espermática poscapacitación, número de folículos, grosor endometrial y número del ciclo en que se realizó la inseminación intrauterina. Las pacientes llevaron un protocolo de estimulación ovárica con seguimiento folicular. Los resultados se analizaron por SPSS 11.0. Las variables continuas se designaron como medias ± DE y regresión logística univariada para determinar la significación estadística. Las categóricas se evaluaron en frecuencias y porcentajes. Se calcularon curvas ROC para determinar los puntos de corte óptimos.
Resultados: se analizaron 391 parejas con 668 ciclos totales. La tasa de embarazo por ciclo y por paciente fue del 13.0 y 21.7%, respectivamente y la edad de 33.5 ± 3.4 años. Las tres variables con p‹0.05 fueron: duración de la infertilidad, movilidad espermática y número del ciclo en que se realizó la inseminación intrauterina. No se encontró significación en el resto de las variables.
Conclusiones: el mayor éxito en la inseminación intrauterina se logra con menos de cuatro años de infertilidad y con movilidad espermática ≥ 77.6% en los primeros dos ciclos de tratamiento.


REFERENCIAS (EN ESTE ARTÍCULO)

  1. Pérez E. Atención integral de la infertilidad. Endocrinología, cirugía y reproducción asistida. México: McGraw Hill, 2003;pp:501-9.

  2. Requena A, Martinez J, Párraga M, Isaza V, Landazábal A, Inseminación artificial. En: Remohí J, Pellicer A, Simón C, Navarro J, editores. Reproducción humana. Madrid: McGraw Hill Interamericana, 2002;pp:263-72.

  3. De Jonge C. Biological basis for human capacitation. Hum Reprod Update 2005;11:205-14.

  4. Allen N, Herbert C, Maxson W, Rogers BJ, et al. Intrauterine insemination: a critical review. Fertil Steril 1985;44:569-80.

  5. Lewis V, Queenan J, Hoeger K, Stevens J, Guzick D. Clomiphene citrate monitoring for intrauterine insemination timing: a randomized trial. Fertil Steril 2006;85:401-6.

  6. Duran H, Morshedi M, Kruger T, Oehnninger S. Intrauterine insemination: a systematic review on determinants of success. Hum Reprod Update 2002;8:373-84.

  7. Campana A, Sakkas D, Stalberg A, Grace P, et al. Intrauterine insemination: evaluation of the results according to the woman’s age, sperm quality, total sperm count per insemination and life table analysis. Hum Reprod 1996;11:732-6.

  8. Karabinus D, Gelety T. The impact of sperm morphology evaluated by strict criteria on intrauterine insemination success. Fertil Steril 1997;67:536-41.

  9. Tomlinson MJ, Amissah JB, Thompson KA, Kasraie JL, Bentick B. Prognostic indicators for intrauterine insemination (IUI): statistical model for IUI success. Human Reproduction 1996;11:1892-6.

  10. Ombelet W, Puttemans P, Bosmans E. Intrauterine insemination: a first-step procedure in the algorithm of male subfertility treatment. Hum Reprod 1995;10(Suppl.1):90-102.

  11. Cohlen BJ, Vandekerckhove P, Te Velde ER, Habbema JD. Timed intercourse versus intrauterine insemination with or without ovarian hyperstimulation for subfertility in men. Cochrane Database Syst Rev 2002;2:CD000360.

  12. Kerin JF, Kirby C, Peek J, Jeffrey R, et al. Improved conception rate after intrauterine insemination of washed spermatozoa from men with poor quality semen. Lancet 1984;1(8376)533-5.

  13. Ho PC, Poon IM, Chan SY, Wang C. Intrauterine insemination is not useful in oligoasthenospermia. Fertil Steril 1989;51:682-4.

  14. Te Velde ER, Van Kooy RJ, Waterreus JJ. Intrauterine insemination of washed husband’s spermatozoa: a controlled study. Fertil Steril 1989;51:182-5.

  15. Martinez AR, Bernardus RE, Voorhorst FJ, Vermeiden JP, Schoemaker J. Intrauterine insemination does and clomiphene citrate does not improve fecundity in couples with infertility due to male or idiopathic factors: a prospective, randomized, controlled study. Fertil Steril 1990;53:847-53.

  16. Kirby CA, Flaherty SP, Godfrey BM, Warnes GM, Matthews CD. A prospective trial of intrauterine insemination of motile spermatozoa versus timed intercourse. Fertil Steril 1991;56:102-7.

  17. Martinez AR, Bernardus RE, Voorhorst FJ, Vermeiden JP, Schoemaker J. Pregnancy rates after timed intercourse intrauterine insemination after human menopausal gonadotropin stimulation of normal ovulatory cycles: a controlled study. Fertil Steril 1991;55:258-65.

  18. Evans J, Wells C, Gregory L, Walker S. A comparison of intrauterine insemination, intraperitoneal insemination, and natural intercourse in superovulated women. Fertil Steril 1991;56:1183-7.

  19. Crosignani PG, Walters DE, Soliani A. The ESHRE multicentre trial on the treatment of unexplained infertility: a preliminary report. Hum Reprod 1991;6:953-8.

  20. Nan PM, Cohlen BJ, T Velde ER, van Kooij RJ, et al. Intra-uterine insemination or timed intercourse after ovarian stimulation for male subfertility? A controlled study. Hum Reprod 1994;9:2022-6.

  21. Melis GB, Paoletti AM, Ajossa S, Guerriero S, et al. Ovulation induction with gonadotropins as sole treatment in infertile couples with open tubes: a randomized prospective comparison between intrauterine insemination and timed vaginal intercourse. Fertile Steril 1995;64:1088-93.

  22. Deaton JL, Clark RR, Pittaway DE, Herbst P, Bauguess P. Clomiphene citrate ovulation induction in combination with a timed intrauterine insemination: the value of urinary luteinizing hormone versus human chorionic gonadotropin timing. Fertil Steril 1997;68:43-7.

  23. Zreik TG, Garcia-Velasco JA, Habboosh MS, Olive DL, Arici A. Prospective, randomized, crossover study to evaluate the benefit of human chorionic gonadotropin-timed versus urinary luteinizing hormone-timed intrauterine inseminations in clomiphene citrate-stimulated treatment cycles. Fertil Steril 1999;71:1070-4.

  24. Kang BM, Wu TC. Effect of age on intrauterine insemination with frozen donor sperm. Obstet Gynecol 1996;88:93-98.

  25. Stone BA, Vargyas JM, Ringler GE, Stein AL, Marrs RP. Determinants of the outcome of intrauterine insemination: analysis of outcomes of 9963 consecutive cycles. Am J Obstet Gynecol 1999;180:1522-34.

  26. Hendin BN, Falcone T, Hallak J, Nelson DR, et al. The effect of patient and semen characteristics on live birth rates following intrauterine insemination: a retrospective study. J Assist Reprod Genet 2000;17:245-52.

  27. Khalil MR, Rasmussen PE, Erb K, Laursen SB, et al. Homologous intrauterine insemination. An evaluation of prognostic factors based on a review of 2473 cycles. Acta Obstet Gynecol Scand 2001;80:74-81.

  28. Montanaro GM, Kruger TF, Coetzee K, Smith K, et al. Stepwise regresion analysis to study male and female factors impacting on pregnancy rate in an intrauterine insemination programme. Andrologia 2001;33:135-41.

  29. OMS. Manual de laboratorio para el examen del semen humano y de la interacción entre el semen y el moco cervical. 4ª ed. Buenos Aires: Editora Panamericana, 2001.

  30. Oehninger S, Acosta A, Morshedi M, Veeck L, et al. Corrective measures and pregnancy outcome in vitro fertilization in patients with severe sperm morphology abnormalities. Fertil Steril 1988;50:283-7.

  31. Goverde AJ, McDonnell J, Vermeiden JP, Schats R, et al. Intrauterine insemination or in vitro fertilisation in idiopathic subfertility and male subfertility: a randomized trial and cost effectiveness analysis. Lancet 2000;355:13-18.

  32. Revised American Society for Reproductive Medicine classification of endometriosis 1996; Fertil Steril 1997;67:817-21.

  33. Dickey RP, Taylor SN, Lu PY, Sartor BM, et al. Effect of diagnosis, age, sperm quality, and number of preovulatory follicles on the outcome of multiple cycles of clomiphene citrate-intrauterine insemination. Fertil Steril 2002;78:1088-95.

  34. Nuojua-Huttunen S, Tomas C, Bloigu R, Tuomivaara L, Martikainen H. Intrauterine insemination treatment in subfertility: an analysis of factors affecting outcome. Hum Reprod 1999;14:698-703.

  35. Flamigni C, Borini A, Violini F. Oocyte donation: comparison between recipients from different age groups. Hum Reprod 1993;8:2088-92.

  36. Cano F, Simon C, Remohi J, Pelicer A. Effect of aging on the female reproductive system: evidence for a role of uterine senescence in the decline in female fecundity. Fertil Steril 1995;64:584-9.

  37. Navot D, Bergh PA, Williams MA. Poor oocyte quality rather than implantation failure as a cause of age-related decline in female fertility. Lancet 1991;337:1375-7.

  38. Abdalla HI, Burton G, Kirkland A. Age, pregnancy and miscarriage: uterine versus ovarian factors. Hum Reprod 1993;8:1512-7.

  39. Iberico G, Vioque J, Ariza N, Lozano JM, et al. Analysis of factors influencing pregnancy rates in homologous intrauterine insemination. Fertl Steril 2004;81:1308-13.

  40. Mathieu C, Ecochard R, Bied V. Cumulative conception rate following intrauterine artificial insemination with husband’s spermatozoa: influence of husband’s age. Hum Reprod 1995;10:1090-7.

  41. Van Waart J, Kruger TF, Lombard CJ, Ombelet W. Predictive value of normal sperm morphology in intrauterine insemination (IUI): a structured literature review. Hum Reprod Update 2001;7:495-500.

  42. Ombelet W, Vandeput H, Van De Putte G, Cox A, et al. Intrauterine insemination after ovarian stimulation with clomiphene citrate: predictive potential of inseminating motile count and sperm morphology. Hum Reprod 1997;12:1458-63.

  43. Van Der Westerlaken LA, Naaktgeboren N, Helmerhorst FM. Evaluation of pregnancy rates after intrauterine insemination according to indication, age, and sperm parameters. J Assist Reprod Genet 1998;15:359-64.

  44. Kruger TF, Menkveld R, Stander FS, Lombard CJ, et al. Sperm morphologic features as a prognostic factor in vitro fertilization. Fertil Steril 1986; 46:1118-23.

  45. Oehnninger S, Acosta AA, Morshedi M, Veeck L, et al. Corrective measures and pregnancy outcome in in vitro fertilization in patients with severe sperm morphology abnormalities. Fertil Steril 1988;50:283-7.

  46. Toner JP, Mossad H, Grow DR, Morshedi M, et al. Value of sperm morphology assessed by strict criteria for prediction of the outcome of artificial (intrauterine) insemination. Andrologia 1995;27:143-8.

  47. Matorras R, Corcostegui B, Perez C, Mandioca M, et al. Sperm morphology analisis (strict criteria) in male infertility is not a prognostic factor in intrauterine insemination with husband’s sperm. Fertil Steril 1995;63:608-11.

  48. Dodson WC, Haney AF. Controlled ovarian hyperstimulation and intrauterine insemination for treatment of infertility. Fertil Steril 1991;55:457-67.

  49. Dickey RP, Olar TT, Taylor SN, Curole DN, Rye PH. Relationship of follicle number ad other factors to fecundability and multiple pregnancy in clomiphene citrate induced intrauterine insemination cycles. Fertil Steril 1992;57:613-9.

  50. Steures P, Van der Steeg JW. Prediction of an ongoing pregnancy after intrauterine insemination. Fertil Steril 2004;82:45-51.

  51. Hughes EG. The effectiveness of ovulation induction and intrauterine insemination in the treatment of persistent infertility: a meta-analisys. Hum Reprod 1997; 12:1865-72.

  52. Daya S, Gumby J, Hughes EG. Randomized controlled trial of follicle stimulating hormone versus human menopausal gonadotrophin in in-vitro fertilization. Hum Reprod 1995;10:1392-6.




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