[The value of paternal age on the outcome of intrauterine insemination]. / El valor de la edad paterna en los resultados de inseminación intrauterina.

BACKGROUND: Although age to conceive has been delayed in both males and females, male age is controversial as decisive for this purpose. OBJECTIVE: To describe the results of intrauterine insemination pregnancy according to the age of the man. To determine whether this variable modifies semen parameters. To analyze whether pregnancy outcomes are modified by sperm morphology. PATIENTS AND METHODS: A descriptive, retrospective, longitudinal and analytical study. We analyzed 2,276 intrauterine insemination cycles performed in the Mexican Center for Fertility CEPAM from January 2000 to December 2012. We included only women under 35 years old without tubal occlusion. Semen parameters were evaluated after capacitation and the pregnancy rate by male age group and sperm morphology was analyzed. The results were analyzed with SPSS 20. Continuous variables were reported as means and their standard deviations and logistic regression univariate to determine the statistical significance. The categorical variables were evaluated in frequencies and percentages. RESULTS: 2,276 intrauterine insemination cycles were pooled according to the age of the male. The lower pregnancy rate was found in the group of men over 50 years. There was negative correlation between the increasing age with the total motile cell volume and morphology. There was only one pregnancy from a male over 50 years. When morphology was less than 4%, the pregnancy rate was significantly lower after 45 years; if it was more than 4% this effect was not observed. CONCLUSION: Male age affects pregnancy outcomes in intrauterine insemination cycles, as long as the sperm morphology is altered.

[Report of the seminal characteristics in patients with consecutive pregnancy to intrauterine insemination and his perinatal complications]. / Influencia del estudio seminal en el éxito de la inseminación intrauterina y en las complicaciones perinatales.

BACKGROUND: It is reported that pregnancies achieved through assisted reproductive techniques have increased risk of complications. There is doubt as to whether this increase is attributable to the underlying infertility or to the assisted reproduction techniques. Postcapacitation seminal parameters have been mentioned as determinants of success. OBJECTIVES: To describe semen parameters of patients at the Mexican Fertility Center (CEPAM) who achieved pregnancy with intrauterine insemination and compare the causes of perinatal morbidity and mortality with those of the general population. PATIENTS AND METHODS: A descriptive, retrospective (2004-2009), analytical and longitudinal study based on analysis of intrauterine insemination cycles that achieved pregnancy with prenatal care and childbirth. The variables studied were: pregnancy, obstetric complications and postcapacitation semen parameters. For the analysis the data was divided according to sperm morphology. The results were analyzed using SPSS-20. Continuous variables were reported as means, and their standard deviations and logistic regression as univariate to determine the statistical significance. The categorical variables were evaluated in frequencies and percentages. RESULTS: 133 cases were analyzed, 78% with normal morphology over 4%, mean semen parameters: 0.63 mL volume, density 82.72 million/mL, progressive motility 88.5% and normal morphology over 4% of 5.93%. The 16.6% of pregnancies were twins. 18.5% was abortion, 69% was cesarean section and 30% vaginal delivery. No differences were found in any of the variables when comparing normal sperm morphology groups lower and higher than 4%, except in patients with abortion. There was no increased incidence of perinatal complications than in the general population. CONCLUSIONS: Perinatal complications incidence is similar to the general population, except in multiple pregnancy. There is more success in intrauterine insemination when the postcapacitation morphology is over 4%.

[Intrauterine insemination results in the Specialized Center for Women's Care]. / Resultados de inseminación intrauterina en el centro especializado para la atención de la mujer.

BACKGROUND: intrauterine insemination should be offered to couples with unexplained infertility, given its effectiveness and compared to in vitro fertilization and embryo transfer, is less invasive and requires less resources. It also should be offered to couples with male factor infertility in selected patients with induction of ovulation to increase the chances of pregnancy. OBJECTIVE: to determine the rate of pregnancy with intrauterine insemination in couples with infertility. MATERIAL AND METHODS: descriptive and retrospective study of 500 couples with female, male and combined infertility, primary or secondary, managed with homologous insemination, with controlled ovarian stimulation and programmed ovulation, in patients with at least one permeable salpinx, FSH <12 IU/L and > 5 x 10(6) mobile and normal sperm. Ultrasonografic follicular follow-up and ovulation triggering according to findings, performing insemination 36 hours after the shooting, with luteal phase support with progesterone. RESULTS: 1.6 cycles on average, female infertility 65.8%, 21% male and combined 13.2%, age average 32 years of women and 36 years of man, average ovarian stimulation 8 days. Pregnancy in 19.5% of the patients, of these, 65.1% under the age of 35 years, 33.3% from 35 to 40 years and 1.5% older than 40 years. Pregnancy at term 77.08%, miscarriage 11.45% and unknown resolution at 11.45%. Twin pregnancy 14.61% and high fetal order 5.7%. Pregnancy with female infertility 64%, male 22.3% and combined 13.5%. Pregnancy with endometrial <8 mm 9.8%, 8-15 mm 86.4% >15 mm 3.6%. With trilaminar endometrium 72.3%, dense 12.5%, linear 0.5%. CONCLUSION: The rate of pregnancy in intrauterine insemination hardly exceeds 20%. The determinants for this are the women age, type of infertility and endometrial characteristics. It was also noted high twin pregnancy and high fetal order.

Estudio prospectivo y aleatorio del impacto de misoprostol (PgE1) en las tasas de embarazo con inseminación intrauterina (IIU): Informe preliminar / A prospective randomized trial of the impact of misoprostol (PgE1) on pregnancy outcome after intrauterine insemination (IUI) therapy: a preliminary study

La aplicación de prostaglandinas (Pg) en el campo reproductivo, aunque controversial, ha jugado un papel importante dentro de los fenómenos fisiológicos del aparato reproductivo humano. Por otro lado, el uso de los procedimientos de hiperestimulación ovárica controlada e inseminación intrauterina incrementan en forma considerable las expectativas reproductivas en ciertos grupos de pacientes. El objetivo de este trabajo fue valorar el efecto del uso de prostaglandinas (específicamente del misoprostol), en las tasas de embarazo, en aquellas pacientes que se encuentren bajo tratamiento específico de hiperestimulación ovárica controlada e inseminación intrauterina. Se estudiaron 59 ciclos de hiperestimulación ovárica e inseminación intrauterina, en donde al grupo de estudio (n=29) se le aplicaron 200 microgramos de prostaglandina E1 (misoprostol) por vía intravaginal inmediatamente después de la inseminación, comparado con el grupo control (n=30), en donde las características demográficas fueron similares. No se observaron diferencias en cuanto a edad, evaluación endocrinológica basal (FSH, LH y estradiol), así como día de la aplicación de la hCG y número de ámpulas utilizadas durante el tratamiento. Sin embargo, un efecto significativo fue encontrado en la tasa de embarazo evaluada por ambos grupos siendo de 20 por ciento en el grupo control comparado con 31 por ciento en el grupo de pacientes con prostaglandinas. A partir de estos resultados hemos podido comprobar el efecto benéfico con el uso de misoprostol en inseminación intrauterina, lo cual se ve reflejado en un incremento en las tasas de embarazo clínico.