Objective: To determine the pregnancy rate after intrauterine insemination using samples with. processed total motile count of 1.0 x 106 and less and describe the semen quality profile of Filipino males with severe male factor infertility in both the raw and processed semen samples. Design: Retrospective descriptive study. Setting: Andrology Laboratory, St. Luke's Medical Center. Patients: 307 infertile Filipino couples who underwent 426 IUI cycles. Main Outcome Measures: Pregnancy rate (PR) after intrauterine insemination. Results: A total of 10 pregnancies were obtained out of 426 IUI cycles, for a pregnancy rate per cycle of 2.4%. Seven of these eventually delivered to term, for a live birth rate of 1.6%. Among those who did not get pregnant with IUI, 8 had spontaneous pregnancies within 1 to 5 year period of follow-up for a spontaneous pregnancy rate of 1.9%. As expected, all the semen parameters analysed showed improvement after semen processing in all subjects. However, these improvements failed to result in a more acceptable pregnancy rate. Among the parameters, morphology was notably better among those who had pregnancies. Conclusion: The chance of pregnancy with IUI using semen samples with processed total motile count of 1.0 x 106 or less is relatively low. For these couples, it may be more prudent to proceed directly to IVF-ICSI than to try several cycles of IUI in futility.
INTRAUTERINE INSEMINATION ; SEVERE OLIGOSPERMIA

To determine the prognostic factors such as age, diagnosis, number of cycle attempts and semen parameters on the pregnancy rate of controlled ovarian hyperstimulation (COH) /intrauterine insemination (IUI). Three hundred and seventeen women who underwent 507 consecutive COH/IUI cycles were recruited from 1st January 2002 to 31st December 2005 inclusively. This retrospective study was done in University Malaya Medical Centre, a tertiary care academic centre. The main outcome measure was pregnancy rate according to age, infertility diagnosis, duration of infertility, semen parameters, and the number of treatment cycles. The overall pregnancy rates were 16.9% per cycle and 25.9% per couple. Pregnancy rates decreased with advancing maternal age. Pregnancy rate was also significantly lower in patient with postwash total motile sperm count (TMSC) < or = 20 million/ml compared to those with TMSC >20 million/ml. The cumulative pregnancy rates varied greatly by diagnosis from 16% for patients with male factor infertility to 60% for patients with ovulatory disorder. Pregnancies among patients with male infertility, tubal factors infertility and endometriosis were achieved during the first three cycles. There is a clear age-related decline in fecundity associated with COH/IUI treatment. Women of > 40 years old, couple with postwash TMSC < or = 20 million/ml, severe endometriosis and tubal factors have a particularly poor prognosis.
Pregnancy ; Infertility ; Intrauterine artificial insemination ; /mL ; Diagnostic

Heterotopic pregnancy, simultaneous intrauterine and extrauterine gestations, is a relatively rare conditon with an estimated incidence of 1 in 30,000 pregnancies in a natural cycle. But the incidence of heterotopic pregnancies has been increased because of rising incidence of pelvic inflammatory disease, pelvic surgery, intrauterine device, the use of various ovulation induction and assisted reproductive technologies, such as in vitro fertilization and embryo transfer, gamate intrafallopian insemination. The early diagnosis of heterotopic pregnancy is very difficult. So there is a higher maternal morbidity, mortality and fetal loss. Thus careful pelvic examination, combined with serial beta hCG determinations and transvaginal sonography to evaluate the adnexal region are important. We experienced a case of 34-years-old multiparous women with heterotopic pregnancy in natual cycle confirmed by surgical removal of ruptured right tubal pregnancy and sonographic finding of the intrauterine pregnancy, which carried the intrauterine pregnancy to term delivery without complication at 39+5 weeks of gestation, and report this case with a brief review of the literature.
Early Diagnosis ; Embryo Transfer ; Female ; Fertilization in Vitro ; Fertilization* ; Gynecological Examination ; Humans ; Incidence ; Insemination ; Intrauterine Devices ; Mortality ; Ovulation Induction ; Pelvic Inflammatory Disease ; Pregnancy ; Pregnancy, Heterotopic* ; Pregnancy, Tubal ; Reproductive Techniques, Assisted ; Ultrasonography