Preventing Pertussis: Are Your Patients and Their Families ‘Cocooning’?

COMMENTARY Does Single or Double InseminationDuring Ovulation Induction Cycle IncreasePregnancy Rates? By Michael A. Thomas, MD Professor, Fellowship and Division Director, Section of Reproductive Endocrinology and Infertility, University of Cincinnati Academic Health Center Dr. Thomas reports no financial relationships relevant to this field of study. SYNOPSIS: Performing intrauterine insemination with the use of donor sperm twice during a natural or stimulated ovulation inductioncycle did not increase pregnancy rates over a single insemination. SOURCE: Zarek SM, et al. Single-donor and double-donor sperm intrauterine insemination cycles: Does double intrauterine inseminationincrease clinical pregnancy rates? Fertil Steril 2014;102:739-743. T determine whether a single or double intrauterineinsemination (IUI) improves pregnancy outcomes,the authors used a retrospective cohort design in alarge private practice fertility center to observe clinicalpregnancy rates after a natural or stimulated cycle.A total of 3159 donor IUI cycles were studied, ofwhich 673 single and 2486 double inseminations wereperformed. Only cycles utilizing donor sperm wereincluded in the evaluation and no other exclusions wereused. Prior to each insemination, frozen donor sperm wasthawed and washed to remove the seminal fluid; then thesupernatant was re-suspended in sterile media. A cathetercontaining the sperm was placed directly into the uterus,bypassing the vagina and cervix to concentrate the malegametes in an area closer to the fallopian tubes. Timingof the insemination cycle was done using a urinary testkit to detect the luteinizing hormone (LH) surge orfollowing injection of human chorionic gonadotropin(hCG) to mimic the LH surge. The two study groups(single or double) were similar in age, body mass index,number of cycles prior to the study, chance of havingdiminished ovarian reserve, and type of cycle (naturalvs stimulated). Whether a patient underwent a single ordouble insemination was up to the physician and patient.Utilizing univariate regression and generalized estimationequation modeling, multiple subanalyses were performedto observe potential differences between the methods ofIUI and other factors, including patient demographics,stimulation parameters, first and multiple cycle outcomes,best prognosis patients (< 35 years of age withoutpolycystic ovary syndrome or ovarian reserve issues), andpatients with a decrease in ovarian reserve parameters.The overall clinical pregnancy rates (heartbeat notedon ultrasound in the first trimester) were not significantbetween the two groups: single 16.4% and double13.6%. Also, no differences in outcome were notedduring the first cycle (single 17%, double 14.4%) or ingood prognosis patients (single 23.3%, double 18.9%).From a cost-effectiveness perspective, the authors notedthat the cost of an extra insemination at their institutionadded an additional $800 to the cost of the total cyclewithout noted benefit. n COMMENTARYThe use of intrauterine insemination with partner ordonor sperm is a useful technique for couples withunexplained and male infertility without utilizing highercost techniques such as in vitro fertilization. Whethera single or double insemination should be performedduring an individual ovulation induction cycle is a