An Evaluation of Couples Undergoing Intrauterine Insemination in a Clinic in Johannesburg

Abstract

Background: Infertility is a common reason for consultation in Gynaecology. Most cases of infertility can be treated with assisted reproductive techniques (ART). However, assisted reproductive therapy is still largely unavailable or inaccessible in most low- and middle-income countries. Intrauterine insemination (IUI), which consists of the deposition of processed sperm from the partner or donor into the cavity of the uterus around ovulation time, is one of the oldest methods. Objective: To describe couples who underwent IUI and determine predictors of successful IUI. Methods: A retrospective descriptive study of all couples who underwent IUI at the BioArt Fertility Centre in Johannesburg from January 2019 to June 2021. In total, 451 IUI cycles were analysed in 273 couples. The main outcome measure was a positive serum quantitative pregnancy test 14 days after IUI. Multivariate logistic regression was done to find predictors of successful IUI. Results: The mean male age was 37.15 years (SD±5.16) with most male participants having a processed total motile sperm count (PTMSC) of > 39 x 106/ml. The mean female age was 33.51 years (SD±4.83). Most females had primary infertility, and the median duration of infertility was three years. The main etiology of infertility was ovulatory dysfunction (37.7%). The overall pregnancy rate per cycle was 13.1%, comprising 56 clinical and three biochemical pregnancies. Letrozole was the main ovarian stimulation agent (86%). The PTMSC, female age, duration of infertility, and follicle size significantly increased the pregnancy rate with p- value <0.05. Conclusion: IUI is an effective choice of therapy for infertility in selected couples, achieving acceptable pregnancy rates for up to three treatment cycles, especially in females < 40 years with less than five years’ duration of infertility, and in males with a PTMSC of > 39 x 106/ml.