Efficacy of intrauterine insemination in women with endometrioma-associated subfertility: analysis using propensity score matching

BMC Pregnancy Childbirth. 2022 Jan 4;22(1):12. doi: 10.1186/s12884-021-04342-y.


Background: Intrauterine insemination (IUI) treatment is recommended in subfertile women with AFS/ASRM stage I/II endometriosis. However, the efficacy of IUI in women with ovarian endometriomas with tubal patency is uncertain. We explored the efficacy of IUI for the treatment of endometrioma-associated subfertility.

Methods: We performed a retrospective matched cohort study using propensity matching (PSM) analysis. Subfertile couples undergoing IUI with and without ovarian stimulation between January 1, 2015, and May 30, 2020 were reviewed.

Results: After PSM, 56 women with endometrioma alone were matched to 173 patients with unexplained subfertility. The per-cycle pregnancy rate (PR) was comparable between women with endometrioma-associated subfertility (n = 56, 87 cycles) and women with unexplained subfertility (n = 173, 280 cycles) (9.2% vs. 17.9%, OR 0.47; 95% CI, 0.21-1.03). Subgroup analyses based on IUI with or without stimulation also resulted in comparable results. A trend toward a lower cumulative pregnancy rates (CPRs) was seen in women with endometrioma (14.3%, 8/56) compared with women with unexplained subfertility (28.9%, 50/173), but the differences were not significant (HR 0.49; 95% CI, 0.23-1.15). However, patients with endometrioma were nearly twice as likely to converse to IVF treatment compared with those without the disease (60.7% versus 43.9%; OR 1.97; 95% CI, 1.07-3.65).

Conclusion: IUI may be a viable approach for subfertile women with endometrioma and no other identifiable infertility factor. More studies are needed to reassure the findings.

Keywords: Endometrioma; Intrauterine insemination; Propensity score matching; Subfertility.

MeSH terms

  • Adult
  • Cohort Studies
  • Endometriosis / complications*
  • Female
  • Humans
  • Infertility, Female / etiology*
  • Infertility, Female / therapy*
  • Insemination, Artificial / methods*
  • Ovarian Diseases / complications*
  • Ovulation Induction
  • Pregnancy
  • Pregnancy Rate
  • Propensity Score
  • Retrospective Studies
  • Treatment Outcome