Endometriosis-Associated Infertility: Double Intrauterine Insemination Improves Fecundity in Patients Positive for Antiendometrial Antibodies

Problem Prospective registry study evaluating effects of endometriosis (E) and serum antiendometrial antibodies (AEA) on fecundity in intrauterine insemination (IUI) cycles. Method of study AEA assays on 572 consecutive women receiving 969 single and 274 double IUI cycles. Logistic regression was utilized. Results Fecundity was 11.5% (143/1243 cycles). Double IUI improved fecundity with significance achieved in certain study groups. Compared to the AEA- subgroup, all study groups except for the E+ AEA- group had significantly lower fecundity. Two study groups receiving double IUI had significantly increased fecundity, E- AEA+ (OR: 5.1, CI: 1.1-22.7, P = 0.032) and E+ AEA+ (OR: 4.1, CI: 1.2-14.0, P = 0.025) and significant predictors of pregnancy (E- AEA+, OR: 7.8, CI: 1.7-36.2, P = 0.009 and E+ AEA+, OR: 4.2, CI: 1.2-15.1, P = 0.026). Conclusion Double IUI improves fecundity in AEA+ patients. E-associated infertility is better diagnosed by the AEA assay than by surgery. Double IUI should be attempted prior to assisted reproductive technologies in AEA+ patients with normal fallopian tubes.