Quality of cervical mucus and Huhner's test

Illustrations of the Value of the Microscope in the Treatment of the Sterile Condition

Sims JM, 1868·Br Med J

Is endometrial thickness associated with fertility outcomes in intrauterine insemination? a cohort study

Du T et al., 2025·Fertil Steril

Intrauterine insemination (IUI) is the first line treatment for conditions such as unexplained or mild male factor infertility. Endometrial thickness (EMT) is an important indicator for predicting pregnancy outcomes in in-vitro fertilization. However, published data about whether EMT has a predictive capacity for success in IUI is controversial, and most studies suggest that endometrial thickness is not associated with IUI success, which limits its use in IUI. This was a single center retrospective cohort study that included women undergoing IUI cycles from January 2007 to June 2021. We categorized EMT into thin (<7 mm), medium (7-14 mm), and thick (>14 mm) groups. For all IUI cycles, we computed adjusted odds ratios (aORs) and 95% confidence intervals (CIs) using Generalized Estimating Equation Regression Models. For first IUI cycles specifically, we applied both Inverse Propensity Score Weighted Regression Adjustment Models and Propensity Score Matching Analyses to compare fertility outcomes. Moreover, we computed the predicted probability of primary outcomes for continuous EMT in mm using restricted cubic splines, allowing for non-linear relationships. This cohort included 13103 IUI cycles involving 7609 women. Across all cycles, live birth rates were lower in the thin EMT group (11.0%) and higher in the thick EMT group (16.9%), compared to the medium EMT group (13.5%)-aOR 0.82 (95% CI 0.67-0.998) for thin EMT and aOR 1.22 (95% CI 1.02-1.45) for thick EMT. The results were consistent when analyzing first cycles only. Restricted cubic spline analysis revealed a linear positive gradient that suggests a progressive increase in live birth rates with increasing EMT. In natural or Letrozole with or without Human Menopausal Gonadotropin stimulated IUI cycles, EMT on trigger day is a significant predictor of live birth, with thin EMT associated with reduced success rates. EMT measurements could serve as a useful marker in IUI treatment.

A randomized trial of web-based fertility-tracking software and fecundability

Wise LA et al., 2023·Fertil Steril

To assess the effect of randomization to FertilityFriend.com, a mobile computing fertility-tracking app, on fecundability. Parallel non-blinded randomized controlled trial nested within the Pregnancy Study Online (PRESTO), a North American preconception cohort. PATIENT(S): Female participants aged 21 to 45 years attempting conception for ≤6 menstrual cycles at enrolment (2013-2019). Randomization (1:1) of 5532 participants to receive a premium Fertility Friend (FF) subscription. MAIN OUTCOME MEASURE(S): Fecundability (per-cycle probability of conception). Participants completed bimonthly follow-up questionnaires until pregnancy or a censoring event, whichever came first. We first performed an intent-to-treat analysis of the effect of FF randomization on fecundability. In secondary analyses, we used a per-protocol approach that accounted for adherence in each trial arm. In both analyses, we used proportional probabilities regression models to estimate fecundability ratios (FR) and 95% confidence intervals (CI) comparing those randomized vs. not randomized and applied inverse probability weights to account for loss-to-follow-up (intent-to-treat and per-protocol analyses) and adherence (per-protocol analyses only). Using life-table methods, 64% of the 2775 participants randomized to FF and 63% of the 2767 participants not randomized to FF conceived during 12 cycles; these respective percentages were each 70% among those with 0-1 cycles of attempt time at enrolment. Of those randomized to FF, 72% were defined as adherent (68% of observed menstrual cycles). In intent-to-treat analyses, there was no appreciable association overall (FR = 0.97; 95% CI, 0.90-1.04) or within strata of pregnancy attempt time at enrolment, age, education, or other characteristics. In per-protocol analyses, we observed little association overall (FR = 1.06; 95% CI, 0.99-1.14), but weak-to-moderate positive associations among participants who had longer attempt times at enrolment (FR = 1.15; 95% CI, 0.98-1.35 for 3-4 cycles; FR = 1.14; 95% CI, 0.87-1.48 for 5-6 cycles), were aged <25 years (FR = 1.29; 95% CI, 1.01-1.66), had ≤12 years of education (FR = 1.32; 95% CI, 0.92-1.89), or were non-users of hormonal contraception within 3 months before enrolment (FR = 1.10; 95% CI, 1.02-1.19). No appreciable associations were observed in intent-to-treat analyses. In secondary per-protocol analyses that accounted for adherence, randomization to FF was associated with slightly greater fecundability among selected subgroups of participants; however, these results are susceptible to unmeasured confounding.

A Comparison of Two Hormonal Fertility Monitoring Systems for Ovulation Detection: A Pilot Study

Mu Q et al., 2023·Medicina (Kaunas)

Objectives: Accuracy in detecting ovulation and estimating the fertile window in the menstrual cycle is essential for women to avoid or achieve pregnancy. There has been a rapid growth in fertility apps and home ovulation testing kits in recent years. Nevertheless, there lacks information on how well these apps perform in helping users understand their fertility in the menstrual cycle. This pilot study aimed to evaluate and compare the beginning, peak, and length of the fertile window as determined by a new luteinizing hormone (LH) fertility tracking app with the Clearblue Fertility Monitor (CBFM). A total of 30 women were randomized into either a quantitative Premom or a qualitative Easy@Home (EAH) LH testing system. The results of the two testing systems were compared with the results from the CBFM over three menstrual cycles of use. Potential LH levels for estimating the beginning of the fertile window were calculated along with user acceptability and satisfaction. The estimates of peak fertility by the Premom and EAH LH testing were highly correlated with the CBFM peak results (R = 0.99, p < 0.001). The participants had higher satisfaction and ease-of-use ratings with the CBFM compared to the Premom and EAH LH testing systems. LH 95% confidence levels for estimating the beginning of the fertile window were provided for both the Premom and EAH LH testing results. Our pilot study findings suggest that the Premom and EAH LH fertility testing app can accurately detect impending ovulation for women and are easy to use at home. However, successful utilization of these low-cost LH testing tools and apps for fertility self-monitoring and family planning needs further evaluation with a large and more diverse population.