P-051 Results of Intrauterine Insemination (IUI) with donor semen in women with poor ovarian reserve
Authors: Bujalance F , García Lozano J  C , Guisado Fernández J , Lozano Arana M  D , Sánchez Andujar B 
Published: July 2024

Abstract

Study question
If we have a woman with a poor ovarian reserve, will she have a lower chance of pregnancy after a cycle of IUI?

Summary answer
A woman with a poor ovarian reserve has a lower chance of pregnancy, although in donor IUI we have an acceptable rate of pregnancy.

What is known already
Actually, the better predictor to define a poor ovarian reserve is a low antimullerian hormone (AMH). AMH is a well-known predictor of ovarian reserve, which allow to predict a response after an in vitro fecundation (IVF) cycle. Nevertheless, we also know that a low AMH does not mean to be not able to get pregnant.
Few studies have compared different markers of ovarian reserve as predictors of pregnancy after an IUI cycle, and those which have done it have conflictive results. Maternal age seems to be strongly linked with the chance of pregnancy.

Study design, size, duration
We designed a retrospective cohort study with longitudinal follow-up upon the patients who undergo an IUI cycle in a public hospital of third level (Hospital Virgen del Rocio, Seville, Spain). We included 1059 cycles of IUI (383 with conjugal and 676 with donor semen) between 2015 and 2021. These cycles belong to 390 patients (64 with poor ovarian reserve and 326 with normal ovarian reserve).

Participants/materials, setting, methods
We collected data from clinical history which is completed during the visit of the patients. Cohort was stratified between patients with a low AMH (&lt;1.1 ng/ml) and normal AMH (&gt;1.1 ng/ml). We used this cut point following the definition of our regional guideline that includes when we can practice fertility treatments.
Our main variable was pregnancy rate, defining pregnancy as an echography at 7 weeks with at least one embryo with cardiac activity.

Main results and the role of chance
When we compared pregnancy rate between normal ovarian reserve against poor ovarian reserve, we did not find statistically significant results in conjugal IUI independently that we compared by cycle (11.2% in normal ovarian reserve vs 3.8% in poor reserve (p = 0.2)) or by couple (27.97% in normal ovarian reserve vs 8.3% in poor ovarian reserve (p = 0.1)).
We found differences with the same comparison in donor IUI by cycle (20.2% normal reserve vs 6.8% in poor reserve (p = 0.001)) and by couple (56.83% in normal ovarian reserve vs 21.15% in poor reserve (p = 0.001)). Nevertheless, pregnancy rate in IUI was similar to what we will get with an IVF cycle with only one oocyte.
We compared pregnancy rate between normal ovarian reserve patients who undergo a conjugal IUI cycle, with low reserve patients who undergo a donor IUI cycle. When we compared by cycle normal ovarian reserve patients had 11.2% pregnancy rate, while poor ovarian reserve patients had a 6.8% (p = 0.1). When we compared by couple normal ovarian reserve patients had a pregnancy rate of 27.97% while poor ovarian reserve patients had a 21.15% (p = 0.3).
Actually, our regional guide excludes poor ovarian reserve woman of an IVF cycle in the public system.

Limitations, reasons for caution
We had the proper limitations of an observational retrospective study. As we are a public center, we must follow our regional guide which defines whether we can do a treatment or not.

Wider implications of the findings
Patients with a poor ovarian reserve have a lower pregnancy rate during IUI with donor semen. Nevertheless, this rate could be acceptable especially when we cannot offer them an IVF cycle in public healthcare.

Trial registration number
Not applicable