Relationship between semen regurgitation and pregnancy rates with intrauterine insemination

The presence of cervical backflow during intrauterine insemination does not indicate decreased likelihood of pregnancy. This is the first study analyzing the effect of regurgitation on pregnancy outcomes in humans.

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VOLUME 116, ISSUE 6, P1526-1531


LaTasha B. Craig, M.D., Sushila Arya, M.D., Heather R. Burks, M.D., Kaitlin Warta, M.D., M.P.H., Christen Jarshaw, Karl R. Hansen, M.D., Ph.D., Jennifer D. Peck, Ph.D.



To evaluate the relationship between semen regurgitation and intrauterine insemination (IUI) outcomes. We hypothesized that clinical pregnancy rates and live birth rates would be reduced when regurgitation occurred.


Retrospective cohort study.


A university-based reproductive endocrinology and infertility clinic.


Retrospective review of 1,957 IUI cycles performed on 660 patients between July 2007 and May 2012.



Main Outcome Measure(s)

The primary outcome was live birth. Secondary outcomes were positive serum pregnancy result and clinical pregnancy. Risk ratios (RRs) and 95% confidence intervals (CIs) were calculated using a cluster-weighted generalized estimating equations method to estimate modified Poisson regression models with robust standard errors to account for multiple IUI cycles in the same patient.


Live birth rates were similar in IUI cycles with and without regurgitation (6.3% vs. 6.8%, respectively, RR = 0.82, 95% CI [0.53–1.26]). Clinical pregnancy rates in the presence or absence of regurgitation were 10.5% vs. 10.0% (RR = 0.99, 95% CI [0.73–1.35]). Positive serum pregnancy tests after IUI did not differ by regurgitation status (15.0% vs. 15.4%, RR = 0.97, 95% CI [0.75–1.24]). Results were unchanged when adjusted for covariates (age, race and ethnicity, body mass index, duration of infertility, medication, infertility diagnosis, total motile count, and method of sperm preparation).


The presence of regurgitation during the IUI procedure is not related to pregnancy outcome.

Fertility and Sterility

Editorial Office, American Society for Reproductive Medicine

Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders.