Preeclampsia en pacientes infértiles llevadas a inseminación homóloga y heteróloga en el Centro de Biomedicina Reproductiva del valle - Fecundar, Cali, Colombia / Preeclampsia in infertile patients subjected to homologous and heterologous insemination in the centro de Biomedicina Reproductiva del Valle - Fecundar, Cali, Colombia

Objetivo: determinar la incidencia y el riesgo de preeclampsia en pacientes infértiles a las que se les realizó inseminación con semen de donante o de su pareja. Materiales y métodos: cohortes históricas de pacientes a las cuales se les realizó inseminación intrauterina (IIU) homóloga o heteróloga y que lograron embarazo mayor de 20 semanas de gestación, entre enero del 2000 al 31 de diciembre del 2009 en el Centro de Biomedicina Reproductiva del Valle - Fecundar. Se excluyeron pacientes con trastornos endocrinos y metabólicos (Diabetes Mellitus, enfermedades del colágeno) o enfermedades crónicas (hipertensión arterial, trombofilias). El tamaño de la muestra fue de 155 pacientes expuestas a inseminación heteróloga y 310 a inseminación homóloga. Se evaluó la presencia preeclampsia y el resultado perinatal, así como el tipo de inseminación, edad, raza, nivel educativo, índice de masa corporal (IMC en kg/m²), indicación de la inseminación, número de ciclos previos y estrato socioeconómico. Se estimó la incidencia acumulada y se compararon las dos cohortes por medio del RR con su respectivo intervalo de confianza. Se estratificó por edad. Resultados: 428 mujeres cumplieron los criterios de selección. La incidencia de preeclampsia se presentó en un 6% (24/428), un 4% (11/264) en las IIU homólogas y 7,93% (13/164) de las IIU heterólogas. Se encontró que no hay diferencias en el riesgo de preeclampsia de acuerdo con el tipo de inseminación y al ajustar por edad RR: 1.18 (IC 95%: 0,54-2,58). Conclusiones: en la IIU heteróloga se encontró una incidencia mayor de preeclampsia. Sin embargo, no hay asociación con el desarrollo de preeclampsia.

Objective: Determining preeclampsia incidence and risk in infertile patients who have been inseminated with semen from a donor or from their partner. Materials and methods: This study dealt with historical cohorts of patients who had been subjected to homologous or heterologous intrauterine insemination in the Fecundar infertility centre and who had managed to become pregnant for more than 20 weeks gestation between January 2000 and 31st December 2009. Patients suffering endocrine and metabolic disorders (diabetes mellitus, collagen diseases) or chronic diseases (arterial hypertension, thrombophilia) were excluded. Sample size was 155 patients regarding heterologous insemination and 310 for homologous insemination.The presence of preeclampsia and perinatal result were evaluated and type of insemination, age, ethnicity, educational level, body mass index (BMI in Kg/m²), indication of insemination, number of prior cycles and socioeconomic strata were also measured. Accumulated incidence was estimated and two cohorts were compared by RR with respective confidence intervals. Females were stratified by age. Results: 428 females fulfilled the selection criteria. There was 6% (24/428) preeclampsia incidence, 4% (11/264) homologous IUI and 7.93% (13/164) heterologous IUI. No differences were found regarding the risk of preeclampsia according to the type of insemination and after being adjusted for age (1.18 RR; 0.54-2.58 95%CI). Conclusions: Greater preeclampsia incidence was found in heterologous IUI; however, there was no association with the development of preeclampsia.

The Predictive Value of a Single Serum Beta Human Chorionic Gonadotropin Level in Pregnancies Achieved by Intrauterine Insemination and In Vitro Fertilization-Embryo Transfer Program / 대한산부인과학회잡지

OBJECTIVE: To clarify specific serum beta-human chorionic gonadotropin (beta-hCG) levels on 11 days after intrauterine insemination (IUI) and in vitro fertilization-embryo transfer (IVF-ET) that could predict live birth. METHODS: Three hundred ninety-two pregnancies resulting from IUI and IVF-ET procedures between January 1, 1997 and December 31, 2000 were evaluated. Serum quantitative beta-hCG levels were measured 11 days after IUI or ET using standard immunoradiometric assays. Pregnancy outcomes were categorized as spontaneous abortion, biochemical pregnancy, ectopic pregnancy, singleton live birth, or multiple live birth. Statistical analyses were performed by analysis of variances, and Student's t-test. The sensitivity and specificity of serum beta-hCG level for predicting live birth were plotted using receiver-operator-characteristic (ROC) curve. RESULTS: The multiple live birth group has significantly higher serum beta-hCG level among the different pregnancy outcome groups. The beta-hCG level on the eleventh day after IUI and IVF-ET was significantly higher in the live birth group than the non viable pregnancy group. At a threshold level of 65 mIU/ml, the serum beta-hCG level on the eleventh day after IUI had a positive predictive value of 78.9% in predicting live birth with 95% specificity. At a threshold level of 115 mIU/ml, the serum beta human chorionic gonadotropin level on the eleventh day after ET had a positive predictive value of 92.1% with 95% specificity. CONCLUSION: These data suggest that serum beta-hCG level on 11 days after IVF-ET could be a reliable indicator predicting pregnancy outcome.

Comparison of Clinical Outcomes according to the Catheters undergoing Intrauterine Insemination / 대한산부인과학회잡지

OBJECTIVE: To compare the clinical outcomes of intrauterine insemination (IUI) according to the catheter used. MATERIALS AND METHOD: From March 1998 to September 1998, total 95 infertile patients were included in this study. Patients were randomly allocated to TomCat group (n = 39) and Mackler group (n = 56) according to the catheter for insemination. The controlled ovarian hyperstimulation (COH) using luteal long protocol of gonadotropin releasing hormone agonist (GnRH-a) was used in all patients. Statistical analysis was performed using Student's t-test, Fisher's exact test, and x2 test as appropriate. Statistical significance was defined as p < 0.05. RESULTS: The total dose and duration of exogeneous gonadotropin required were similar between the two groups. There were also no significant differences in serum estradiol (E2) level, endometrial thickness and texture on the day of hCG administration between the two groups. However, the percentage of uterine souding due to failure of initial approach was significantly higher in TomCat group compared to Mackler group (23.1% vs. 0%, p < 0.01). The percentage of bleeding after IUI in TomCat group seemed to be higher than that in Mackler group (15.4% vs. 3.6%, p = 0.06), although there was no statistically significant difference between the two groups. There was also no significant difference in the clinical pregnancy rate per patient between the two groups. CONCLUSION: These results suggested that using Mackler catheter might be effective for IUI, especially for the patients with cervical factor infertility.

Pregnancy Rate Following Superovulation with Intrauterine Insemination in Infertile Patients / 대한산부인과학회잡지

OBJECTIVES: To investigate the efficiency of superovulation with intrauterine insemination (IUI) in infertile patients. MATERIALS AND METHODS: Seventy-two cycles of superovulation with IUI in 48 infertile couples in which gonadotrophins were used for hyperstimulation were analysed retrospectively. RESULTS: Overall clinical pregnancy rate was 33.3% per cycle and 45.8% per patient. By the infertility factor, patients with endometriosis showed the lowest pregnancy rate (10%). Cumulative pregnancy rate (CPR), obtained by life-table analysis, increased as the number of cycles increased: 25.0% for one cycle, 33.3% for two cycle, 40% for three cycle and 50% for more than four cycle. CONCLUSIONS: Superovulation with IUI is an effective treatment modality in patients with subfecundity, and is worth while trying prior to in vitro fertilization procedure in those patients.