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Master Thesis

Devenir des couples en infertilité inexpliquée après échecs des inséminations intra-utérines

Abstract : Unexplained infertility is characterized by a fertility evaluation of the couple that does not explain the delay of conception. The recommended process is to perform 4 to 6 cycles of intrauterine inseminations (IUI), then to continue in case of failure by in-vitro fertilization (IVF). However, the journey can be long and stressful for these couples and many of them give up during treatment. The aim of this study is to analyze the future of couples with unexplained infertility after failure of intrauterine inseminations. We performed a single-center retrospective study between February 2008 and December 2014. The included couples had unexplained infertility and got intrauterine inseminations with gonadotropin stimulation and in-vitro fertilization if no live birth was obtained. The main judgement criterion was live birth. Lost to follow-up couples were contacted by questionnaires. Of the 251 included couples, 80 obtained live birth with IUI, 91 underwent IVF and 80 couples were lost to follow-up. Antra follicle count (AFC) appeared as a predictor of live birth in IUI (AFC >20, OR 5.21 [1.34-21.9] p=0.0197). The live birth rate per couple in IVF was 58.2% after an average of 1.4 attempts. The number of good quality embryos (type 1 according to the Veeck classification) was significantly higher in the group obtaining a live birth in IVF (6.04 +/- 3.49 versus 3.68 +/- 3.15, p=0.001), confirmed by the model after variables selection (more than 4 embryos, OR 36.6, p=0.00168). Of the 14 couples answered the questionnaire, of which 11 stopped all treatment in ART. The two main reasons cited were technical constraint of treatment and follow-up (82%) and psychological impact (64%). A high antral follicle count is a predictor of pregnancy in IUI versus IVF. The number of good quality embryos obtained after the simulation is a perdictor of success in IVF. In our study, nearly 48% of couples who did not obtain pregnancy after IUI, do not continue treatment in ou center, probably related to the psychological impact and the technical constraints.
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Master Thesis
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Marie Deville. Devenir des couples en infertilité inexpliquée après échecs des inséminations intra-utérines. Sciences du Vivant [q-bio]. 2018. ⟨dumas-02145683⟩

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