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Frequently,
the goal is to increase the likelihood of pregnancy though the
use of an oral ovulatory Clomiphene Citrate (CC) combined with
an Intra-Uterine Insemination (IUI) procedure. If
you want to learn more about the CC/IUI procedure, please
press HERE and download the available patient information
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Quick Jumps:
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In
order to offer a cost-affective alternative to other more
involved procedures, we offer the CC/IUI procedure as an
attempt to increase "gamete density" (increase the concentration
of eggs and sperm in a given cycle) to improve pregnancy
rates. This
procedure is ideal for a couple with unexplained infertility
or those with minimal distortion of the pelvic anatomy. Those
patients with severe male-factor problems, severe
endometriosis or significantly damaged tubes will not usually
benefit from the CC/IUI procedure.
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The
following data include 1996 - 2000 success rates. At times, we
chose to present cumulative data starting from 1991. Some of the
2000 CC/IUI pregnancies are still ongoing, although all have passed
well into their second and third trimesters. To remain
accurate, however, the statistics are described as Delivered/Ongoing
Pregnancy Rates.
The average infertile
patient has a reduced ability to conceive (fecundability) in a
given month. Normal conception rates are estimated at 20% (20/100)
each month for young
healthy couples engaging in natural intercourse.
Subfertile couples will generally be achieving pregnancy at
only 1-3%
each month, a substantial decrease from the natural conception
rates. These conception rates should be
remembered in order to compare the CC/IUI success rates as
listed below.
Incidentally,
the CC/IUI procedure is sometimes offered by the general
OB/GYN practice. While they can certainly be quite successful,
it is highly recommended that you ask them for their specific
success rates (numerator & denominator) for the CC/IUI
procedure. Essentially, anyone that offers any reproductive
procedures should have their personal success rates available
to counsel the couple.
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The
data below reflects our success rates between 1996-2000:
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| Total Pregnancy Rates |
12% (35/287) |
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Chemical Pregnancies |
3% (1/35) |
| Clinical Pregnancies |
12% (34/287) |
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Spontaneous Losses |
21% (7/34) |
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Ectopic Pregnancies |
3% (1/34) |
| Ongoing/Delivered Rate |
9% (26/287) |
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Approximately
24% of the pregnancies were lost following a positive
pregnancy test. The ongoing/delivered success rates were 9% with this
"lower-tech" procedure. Even so, the success rates
were often three or more times the background pregnancy rates
of the average subfertile couple. By performing these
procedures 3-4 times, the cumulative take-home-baby rates were
between 25 and 33%. Our success rates were entirely consistent with
published literature.
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One
area that is also very important with regards to success is maternal age. For this
reason, the 1996-9 Ongoing/Delivered rates of the CC/IUI procedure are show
below with respect to maternal age:
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On
the vertical axis, one has the pregnancy rates per month
attempt. The horizontal axis (X-axis) reveals the increasing maternal age.
The success rates decreased slightly as the maternal age increased.
We certainly did fewer of the > 39 year old patients with
the CC/IUI procedure because time was simply running out and
more aggressive measures were requested and suggested.
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We
have been performing CC/IUI procedures since 1991, when we
first opened our practice. As of 3/2/2000, we had a total of
51 pregnancies through the CC/IUI procedure.
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| Total CC/IUI Pregnancies |
51 |
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Chemical Pregnancies |
4% (2/51) |
| Clinical Pregnancies |
49 |
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Spontaneous Losses |
22% (11/49) |
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Ectopic Pregnancies |
2% (1/49) |
| Ongoing/Delivered
CC/IUI Pregnancies |
37 |
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The
total loss rates were 27% (14/51). This is higher-than-normal spontaneous loss rates
probably reflected a more difficult type of patient (PCOS: PolyCystic
Ovarian syndrome) or the subtle anti-estrogen affects of the
clomiphene citrate itself.
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Natural
multiple pregnancy rates are about 1%. When adding the oral
ovulatory agent clomiphene citrate to the
regiment, more than one egg may be released. The statistical
chances for multiple pregnancy are certainly enhanced.
Below
are the cumulative Ongoing/Delivered multiple pregnancy rates for
all CC/IUI procedures
performed here at SRMS from 1991-1999:
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Approximately
14% (5/37) of the total pregnancies were twins. We had only one triplet pregnancy
in 1999. Published data can vary, but is generally
accepted that 66% of the multiple pregnancies will be twins,
about 30% triplets and a true minority quadruplets or more. It
would appear that we were right on track with a low triplet
rate of 3%
(1/37).
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Below
are additional links on this web site that may be of
particular interest to the reader regarding CC/IUI Procedures:
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