Prognostic factors affecting outcome of intrauterine insemination procedures at a fertility center in Ondo, South West Nigeria

Background: There is a recent resurgence in the use of intrauterine insemination (IUI) in Nigeria. However, there is a need for a rational use of the procedure so that couples do not waste time and money on ineffective therapy if it is not indicated.Objective: The objective of this study was to identify the possible prognostic factors affecting outcome of IUI among patients undergoing the procedure.Patients and Methods: This is a retrospective review of the case files and treatment protocols of fifty consecutive couples who had IUI procedure following the established diagnosis of Infertility at the Paramount Fertility Center of Paramount Specialist Hospital Ondo, Nigeria, over a period of 1 year (February 2016 to January 2017).Results: There were ten (20.0%) pregnancies recorded, of which three (6%) clients had first‑trimester miscarriages (between the 5th and 13th weeks), one (2%) had an ectopic pregnancy, whereas six (12%) were carried to the age of viability and delivered. Forty (80%) clients did not achieve pregnancy. The postwash concentration of sperm was noticed to be the only parameter significantly affecting the rate of pregnancy in our treatment cycles with P < 0.05. There was also a trend toward a reduction in pregnancy after the age of 40.Conclusion: This study shows that the postwash sperm count and age of the female have the most predictive value for IUI clinical pregnancy outcome in our center.Keywords: Infertility; intrauterine insemination; prognostic factor

Prognostic factors affecting outcome of intrauterine insemination procedures at a fertility center in Ondo, South West Nigeria

Background: There is a recent resurgence in the use of intrauterine insemination (IUI) in Nigeria. However, there is a need for a rational use of the procedure so that couples do not waste time and money on ineffective therapy if it is not indicated. Objective: The objective of this study was to identify the possible prognostic factors affecting outcome of IUI among patients undergoing the procedure. Patients and Methods: This is a retrospective review of the case files and treatment protocols of fifty consecutive couples who had IUI procedure following the established diagnosis of Infertility at the Paramount Fertility Center of Paramount Specialist Hospital Ondo, Nigeria, over a period of 1 year (February 2016 to January 2017). Results: There were ten (20.0%) pregnancies recorded, of which three (6%) clients had first-trimester miscarriages (between the 5th and 13th weeks), one (2%) had an ectopic pregnancy, whereas six (12%) were carried to the age of viability and delivered. Forty (80%) clients did not achieve pregnancy. The postwash concentration of sperm was noticed to be the only parameter significantly affecting the rate of pregnancy in our treatment cycles with P < 0.05. There was also a trend toward a reduction in pregnancy after the age of 40. Conclusion: This study shows that the postwash sperm count and age of the female have the most predictive value for IUI clinical pregnancy outcome in our center

Adaptation of the Wound Healing Questionnaire universal-reporter outcome measure for use in global surgery trials (TALON-1 study): mixed-methods study and Rasch analysis

BackgroundThe Bluebelle Wound Healing Questionnaire (WHQ) is a universal-reporter outcome measure developed in the UK for remote detection of surgical-site infection after abdominal surgery. This study aimed to explore cross-cultural equivalence, acceptability, and content validity of the WHQ for use across low- and middle-income countries, and to make recommendations for its adaptation.MethodsThis was a mixed-methods study within a trial (SWAT) embedded in an international randomized trial, conducted according to best practice guidelines, and co-produced with community and patient partners (TALON-1). Structured interviews and focus groups were used to gather data regarding cross-cultural, cross-contextual equivalence of the individual items and scale, and conduct a translatability assessment. Translation was completed into five languages in accordance with Mapi recommendations. Next, data from a prospective cohort (SWAT) were interpreted using Rasch analysis to explore scaling and measurement properties of the WHQ. Finally, qualitative and quantitative data were triangulated using a modified, exploratory, instrumental design model.ResultsIn the qualitative phase, 10 structured interviews and six focus groups took place with a total of 47 investigators across six countries. Themes related to comprehension, response mapping, retrieval, and judgement were identified with rich cross-cultural insights. In the quantitative phase, an exploratory Rasch model was fitted to data from 537 patients (369 excluding extremes). Owing to the number of extreme (floor) values, the overall level of power was low. The single WHQ scale satisfied tests of unidimensionality, indicating validity of the ordinal total WHQ score. There was significant overall model misfit of five items (5, 9, 14, 15, 16) and local dependency in 11 item pairs. The person separation index was estimated as 0.48 suggesting weak discrimination between classes, whereas Cronbach's α was high at 0.86. Triangulation of qualitative data with the Rasch analysis supported recommendations for cross-cultural adaptation of the WHQ items 1 (redness), 3 (clear fluid), 7 (deep wound opening), 10 (pain), 11 (fever), 15 (antibiotics), 16 (debridement), 18 (drainage), and 19 (reoperation). Changes to three item response categories (1, not at all; 2, a little; 3, a lot) were adopted for symptom items 1 to 10, and two categories (0, no; 1, yes) for item 11 (fever).ConclusionThis study made recommendations for cross-cultural adaptation of the WHQ for use in global surgical research and practice, using co-produced mixed-methods data from three continents. Translations are now available for implementation into remote wound assessment pathways