Enhancing intrauterine insemination success in advanced maternal age: Impact of consecutive ejaculate and optimised cycle parameters.

OBJECTIVE

This study evaluated whether consecutive ejaculate (CE) strategies improve intrauterine insemination (IUI) live birth rates (LBR) in women over 35 with unexplained or male-factor infertility. It also examined the influence of follicle number and sperm count thresholds on outcomes.

METHODS

In this retrospective cohort study (2010-2019), 596 IUI cycles were analysed in 263 nulliparous women-230 with CE and 366 with standard IUI. Among them, 98 patients underwent CE IUI and 165 received non-CE IUI. Patients with total motile sperm count (TMSC) <5×106 were often fast-tracked to IVF, but CE was mostly attempted to boost sperm count beforehand. LBRs per cycle and per woman were compared between groups.

RESULTS

LBR per cycle was 11.3% (CE) vs. 13.1% (control) (p=0.52); per woman, 26.5% (CE) vs. 29.1% (control) (p=0.65). Mean ages were similar (37.7 vs. 38.0 years; p=0.34). Success improved with TMSC >10×106; 65.4% (CE) and 87.5% (control). Over six cycles, LBR rose from 10.5% to 13.8% (CE) and 12.3% to 16.7% (control). Outcomes improved with two or three follicles, especially in women over 35.

CONCLUSIONS

CE IUI yields LBRs comparable to standard IUI and may offer a cost-effective, less invasive alternative to IVF for male-factor infertility in women over 35. The LBRs per woman undergoing IUI were of a similar magnitude to those reported in IVF cycles. Optimising IUI LBR may involve increasing follicle numbers and using a higher TMSC threshold (>10×106). CE IUI supports healthcare sustainability while expanding fertility treatment access.