Annals of International Medical and Dental Research
Annals of International Medical and Dental Research (AIMDR) is indexed in EMBASE (Elsevier), NCBI, Index Medicus (IMSEAR), Global Index Medicus, Index Copernicus, CABI, ISMTE and Google Scholar
Annals of International Medical and Dental Research
Annals of International Medical and Dental Research (AIMDR) is indexed in EMBASE (Elsevier), NCBI, Index Medicus (IMSEAR), Global Index Medicus, Index Copernicus, CABI, ISMTE and Google Scholar
Bhaskara Byreddy, Kamalieshree Manickam, Madhumala Hassan Ramachandra, Ramach and Raiah Rangadhamaiah
Annals of International Medical and Dental Research (AIMDR) | Vol-11, Issue- 6 | November-December 2025 | Page: 1-8
To compare the effect of intrathecal buprenorphine versus buprenorphine in the transversus abdominis plane block on post-operative nausea and vomiting among subjects undergoing elective cesarean section: A randomized comparative study
Bhaskara Byreddy, Kamalieshree Manickam, Madhumala Hassan Ramachandra, Ramach and Raiah Rangadhamaiah
Abstract
Introduction: Post-operative nausea and vomiting (PONV) remain a significant clinical challenge following cesarean delivery, particularly when neuraxial opioids are used. Intrathecal opioids activate central chemoreceptor trigger zones and disrupt gastric motility, contributing to high PONV incidence (30–80%). The transversus abdominis plane (TAP) block offers peripheral analgesia without central opioid-related adverse effects. This study compares the efficacy of intrathecal buprenorphine versus buprenorphine administered through TAP block on PONV incidence and post-operative analgesia in cesarean delivery. Methods: A randomized comparative study enrolled 60 parturients undergoing elective cesarean section (CS) under spinal anesthesia. Group SB (n = 30) received intrathecal buprenorphine, while Group TB (n = 30) received ultrasound-guided TAP block with buprenorphine. Primary outcomes included PONV scores using the Likert scale, vomiting episodes, and rescue antiemetic requirements. Secondary outcomes measured pain severity (Visual Analog Scale [VAS] scores), time to first analgesic request, and opioid consumption over 24 h. Statistical analysis of categorical and continuous variables were done using descriptive statistics, and compared between groups using independent sample t-tests and Chi-square tests. Results: Group TB demonstrated significantly superior outcomes: PONV scores were markedly lower at 4, 6, and 12 h (P < 0.0001); fewer vomiting episodes (P = 0.007); reduced rescue antiemetic requirement (10% vs. 46.6%, P = 0.004); prolonged analgesic duration (423.9 ± 66.5 vs. 348.8 ± 46.4 min, P = 0.0001); and decreased paracetamol consumption (43.8 ± 4.4 vs. 48.8 ± 7.4 g/kg, P = 0.002). Early VAS scores (4–6 h) were significantly lower in Group TB (P = 0.0001), up to 24 h. Conclusion: TAP blocks with buprenorphine provide superior post-operative analgesia with substantially reduced PONV compared to intrathecal buprenorphine, this approach is particularly beneficial for women at high risk of PONV and those requiring early mobilization. Incorporating TAP blocks into multimodal analgesia regimens for CS can enhance patient comfort and lead to better clinical outcomes.
Buprenorphine, Cesarean section, Nerve block, Post-operative nausea and vomiting, Spinal anesthesia
Ishrat Jahan, Jesmin Akter Mitu, Mehdi Pervez, Sanjib Kundu, Maruf Hossain, Sheikh Anisul Haque
Annals of International Medical and Dental Research (AIMDR) | Vol-11, Issue- 6 | November-December 2025 | Page: 9-17
Antibiotic sensitivity pattern of typhoid fever – experience from a tertiary care hospital in Bangladesh
Ishrat Jahan, Jesmin Akter Mitu, Mehdi Pervez, Sanjib Kundu, Maruf Hossain, Sheikh Anisul Haque
Abstract
Background: Typhoid fever remains a significant pediatric health burden in Bangladesh, compounded by rising antimicrobial resistance. This study aimed to describe the demographic, clinical, and antimicrobial susceptibility patterns of Salmonella Typhi isolates in pediatric patients at a tertiary care hospital in Dhaka. Methods: A retrospective review was conducted of 155 culture-confirmed pediatric typhoid cases from January to December 2024. Demographic, clinical, and microbiological data were analyzed using the Statistical Package for the Social Sciences v25. Results: Most cases occurred in children aged 9–12 years (50.3%) and 5–8 years (40.0%), with a male predominance (58.1%) and urban residence (67.7%). Resistance to first-line agents was high: Ampicillin (62.6%), chloramphenicol (59.3%), and trimethoprim-sulfamethoxazole (54.9%). Fluoroquinolone (FQ) non-susceptibility was present in 54.8% of isolates. In contrast, susceptibility to ceftriaxone (95.6%), cefixime (93.4%), azithromycin (92.3%), and meropenem (100%) remained high. Multidrug resistance was noted in 29.0% of cases, with rare extensively drug-resistance isolates (1.3%). Median time to defervescence was 5 days, with a mean hospital stay of 7.4 ± 2.8 days, and in-hospital mortality was 0.7%. Conclusion: Pediatric typhoid fever in Bangladesh continues to exhibit high resistance to first-line agents and substantial FQ non-susceptibility, underscoring the importance of updated empirical therapy guidelines and rigorous surveillance.
Antimicrobial resistance, Bangladesh, ceftriaxone, pediatrics, typhoid fever
Ishrat Jahan, Shahreen Barkat, Rumana Sharmeen, Nadia Huq, Sanjib Kundu
Annals of International Medical and Dental Research (AIMDR) | Vol-11, Issue- 6 | November-December 2025 | Page: 18-24
Clinical complications and outcomes in preterm low-birth-weight neonates: A study in a neonatal intensive care unit
Ishrat Jahan, Shahreen Barkat, Rumana Sharmeen, Nadia Huq, Sanjib Kundu
Abstract
Background: Preterm low-birth-weight (LBW) neonates represent a critically vulnerable population in neonatal intensive care units (NICUs). This study evaluated the clinical complications, interventions, and short-term outcomes among preterm LBW neonates admitted to a tertiary-level NICU in Bangladesh.
Methods: This retrospective observational study included all preterm LBW neonates admitted to the NICU of Bangladesh Specialized Hospital from June to December 2024. Demographic characteristics, therapeutic interventions, and short-term outcomes were analyzed. Binary logistic regression identified independent predictors of survival.
Results: Seventy-two neonates were included; 50.0% were early preterm, and 87.5% weighed <1,500 g. The most common complications were respiratory distress syndrome (RDS) (80.6%), jaundice (84.7%), hypoglycemia (38.9%), and sepsis (22.2%). Continuous positive airway pressure (CPAP) was used in 80.6% of cases, while only 4.2% required mechanical ventilation; surfactant therapy was not used. The mean NICU stay was 14.8 ± 8.2 days. Overall, survival was 95.8 %, with three deaths – all in extremely LBW, early-preterm infants. Logistic regression showed that each additional week of gestation (odds ratio [OR] 1.68; P = 0.004) and each extra kilogram of birth weight (OR 3.06; P = 0.022) significantly increased survival, while RDS showed a borderline negative association (OR 0.42; P = 0.061). Follow-up attendance on day 7 post-discharge was 100%, and early readmission occurred in 4.2% of cases.
Conclusion: Preterm LBW neonates can achieve higher survival in specialized NICUs with administration of early CPAP care, proper monitoring, and structured follow-up. Gestational age, birth weight, and adequate duration of intensive support remain the key determinants of outcome.
Bangladesh, clinical outcomes, low birth weight, neonatal intensive care units, preterm neonates
Digesh Balachandran, S. Ambika, A. Rita Zarina
Annals of International Medical and Dental Research (AIMDR) | Vol-11, Issue- 6 | November-December 2025 | Page: 25-30
Success of clinical interventions for cessation of thumb-sucking habit in children: An interventional study
Digesh Balachandran, S. Ambika, A. Rita Zarina
Abstract
Context: Digit-sucking is a prevalent developmental occurrence in pre-adolescent children. While deemed typical behavior in youngsters up to 4 years of age, prolonged thumb-sucking has been linked to dental issues, social embarrassment, and parental concerns.
Aims: The study aims to evaluate the efficacy of treatment therapies for the cessation of thumb-sucking behavior in children.
Setting and Design: This study determines which interventional technique works most effectively for the cessation of the finger sucking habit.
Materials and Methods: An interventional study, a non-blinded randomized trial, was carried out on children of age group 6–10 years with thumb-sucking habit, who reported to the outpatient wing of the tertiary dental settings to compare three different management modalities for thumb-sucking intervention, which were: Psychological therapy involving motivational interviewing/counseling, appliance therapy oriented toward malocclusion correction and appliance therapy targeting habit intervention only.
Results: Comparing the success of these three clinical interventions for cessation of thumb sucking habit, the psychological approach was found to yield the best results. Patient satisfaction with the intervention was found to be highly significant for the psychological approach when compared to appliance therapy. Patient/parent satisfaction for the intervention was found to be highly significant for the psychological approach when compared to appliance therapy.
Conclusion: Even though various clinical interventions for cessation of thumb sucking are available, the psychological approach involving motivational interviewing/counseling was found to be a simple, cost-effective, and essential aid for managing thumb-suckers.
Clinical Significance: This study emphasizes the importance of understanding the child’s emotional background in habit intervention protocols
Appliance therapy, interventional study, psychological approach, thumb sucking
Traditional lipid fractions and renal function in a rural Bangladeshi cohort: Correlation findings
Mohammad Ferdous Azad, Md. Ayub Ali Chowdhury, Farhad Ahmed, Shuma Ikram, SM Nafeez Imtiaz, Dilder Hossain Badal
Annals of International Medical and Dental Research (AIMDR) | Vol-11, Issue- 6 | November-December 2025 | Page: 31-40
Traditional lipid fractions and renal function in a rural Bangladeshi cohort: Correlation findings
Mohammad Ferdous Azad, Md. Ayub Ali Chowdhury, Farhad Ahmed, Shuma Ikram, SM Nafeez Imtiaz, Dilder Hossain Badal
Abstract
Background: Dyslipidemia is increasingly recognized as a contributor to renal dysfunction, yet community-level evidence from rural South Asia remains limited. This study examined the association between traditional lipid fractions and renal function among adults in a rural Bangladeshi cohort.
Methods: A cross-sectional study was conducted among 201 adults from Baidyerbazar Union, Sonargaon, Bangladesh. Sociodemographic, clinical, and biochemical data were collected through structured interviews and fasting blood tests. Renal function was assessed using serum creatinine, estimated glomerular filtration rate (eGFR, Modification of Diet in Renal Disease), and urine albumin-to-creatinine ratio (ACR). Traditional lipid markers (triglycerides [TG], total cholesterol [TC], low-density lipoprotein cholesterol [LDL-C], high-density lipoprotein cholesterol [HDL-C]) and non-traditional markers (apolipoprotein A1, apolipoprotein B, lipoprotein [a]) were measured. Correlation analyses and group comparisons were performed.
Results: Mean lipid levels indicated widespread dyslipidemia: TG 182.98 ± 104.94 mg/dL, TC 196.35 ± 47.44 mg/dL, LDL-C 121.04 ± 39.07 mg/dL, and HDL-C 38.97 ± 6.65 mg/dL. Albuminuria (ACR ≥30 mg/g) was present in 23.4% of participants. eGFR showed significant inverse correlations with TG (r = −0.242, P = 0.001), TC (r = −0.342, P < 0.001), and LDL-C (r = −0.258, P < 0.001). Participants with renal impairment had significantly higher TG, TC, and LDL-C (all P < 0.01). Non-traditional lipid markers showed limited association with renal indices.
Conclusion: Traditional lipid abnormalities are strongly linked to early renal dysfunction in this rural Bangladeshi population. Community-based lipid and renal screening may facilitate early identification of high-risk individuals.
Dyslipidemia, estimated glomerular filtration rate, renal function, rural Bangladesh, triglycerides
Md. Sohel Rana, Md. Minhaz Uddin, Md Golam Forhad, Md Mahmudul Hassan, Sarwar Ibne Salam, Quazi Shahid-Ul-Alam
Annals of International Medical and Dental Research (AIMDR) | Vol-11, Issue- 6 | November-December 2025 | Page: 41-48
Evaluation of correction of genu varum and genu valgum deformities by temporary hemiepiphysiodesis using an eight-plate in children
Md. Sohel Rana, Md. Minhaz Uddin, Md Golam Forhad, Md Mahmudul Hassan, Sarwar Ibne Salam, Quazi Shahid-Ul-Alam
Abstract
Background: Genu varum and genu valgum are common angular deformities in children, which may affect gait, joint alignment, and long-term musculoskeletal health if left untreated. Temporary hemiepiphysiodesis using an eight-plate provides a minimally invasive method for guided correction. This study aimed to evaluate the efficacy and outcomes of eight-plate hemiepiphysiodesis in correcting these deformities.
Materials and Methods: This quasi-experimental prospective interventional study was conducted from January 2020 to December 2021 at Dhaka Medical College Hospital and selected private hospitals in Dhaka, Bangladesh. The study included 20 children with clinically and radiologically confirmed genu varum (n = 4) or genu valgum (n = 16) undergoing temporary hemiepiphysiodesis with an eight-plate. Clinical and radiographic follow-up was performed every 3 months, and implants were removed after achieving correction. Data on demographics, deformity type, side and bone involvement, radiological parameters, and outcomes were analyzed using the Statistical Package for the Social Sciences version 26.0.
Results: Mean age was 7.9 ± 3.8 years; 75% were male. In genu varum, intercondylar distance improved from 13.25 ± 2.37 cm to 8.5 ± 0.33 cm. In genu valgum, inter-malleolar distance decreased from 13.19 ± 1.60 cm to 9.44 ± 1.01 cm, with mechanical lateral distal femoral angle improving from 78.75° to 84.85° and medial proximal tibial angle from 89.25° to 88°. Overall, 95% of patients achieved satisfactory outcomes.
Conclusion: Temporary hemiepiphysiodesis using an eight-plate is a safe and effective method for correcting genu varum and genu valgum in children, enabling controlled gradual correction while preserving normal growth.
Eight-plate, Genu valgum, Genu varum, Hemiepiphysiodesis
Gonadotropin therapy for non-obstructive azoospermia and severe oligospermia: Treatment efficacy
Kumer Tanshen, Panchami Goshwami, Florida Rahman
Annals of International Medical and Dental Research (AIMDR) | Vol-11, Issue- 6 | November-December 2025 | Page: 49-58
Gonadotropin therapy for non-obstructive azoospermia and severe oligospermia: Treatment efficacy
Kumer Tanshen, Panchami Goshwami, Florida Rahman
Abstract
Background: Male infertility contributes to nearly half of all infertility cases worldwide and poses a significant clinical and social challenge in South Asia. Non-obstructive azoospermia (NOA) and severe oligospermia are among the most severe forms, often linked to testicular failure and poor natural conception rates. Gonadotropin therapy, combining human chorionic gonadotropin (hCG) and follicle-stimulating hormone (FSH) to stimulate endogenous spermatogenesis, has shown promising results in restoring sperm production, particularly in hypogonadotropic men. This study was conducted to evaluate the efficacy and safety of gonadotropin therapy in improving spermatogenesis among Bangladeshi men with NOA and severe oligospermia.
Methods: This 1-year (start-to-end) observational study was conducted at the Reproductive Endocrinology and Infertility Unit, Dhaka Medical College Hospital, involving 63 men with NOA or severe oligospermia. All participants received hCG for 3 months; non-responders then received an FSH add-on for another 3 months. Semen analysis and hormonal profiling (luteinizing hormone [LH], FSH, testosterone, prolactin) were performed before and after treatment per World Health Organization 2021 guidelines. Treatment response was defined as sperm appearance in the ejaculate or a ≥3 million/mL increase in concentration. Data were analyzed using the Statistical Package for the Social Sciences 26; P < 0.05 was considered statistically significant.
Results: Among 63 participants (mean age 32.9 ± 4.3 years), secondary subfertility was more common (61.9%), and over half were overweight (mean Body mass index [BMI] = 23.6 ± 2.4 kg/m2). Gonadotropin therapy led to significant improvements in sperm concentration (2.1 ± 1.7 → 7.9 ± 3.4 million/mL; P < 0.001) and total sperm count (4.2 ± 3.7 → 10.6 ± 5.4 million; P < 0.001), while motility showed a non-significant upward trend. Testosterone levels increased significantly after therapy (3.5 ± 1.1 → 4.1 ± 1.0 ng/mL; P < 0.001). The proportion of azoospermic men decreased from 38.1% to 31.7%, and those with sperm ≥3 million/mL rose to 58.8%. Responders had higher baseline BMI, LH, and prolactin; all were independent predictors of success. Most responders (88.9%) were hypogonadotropic, and treatment was well tolerated, with only mild, transient adverse events.
Conclusion: Combined hCG and FSH therapy significantly enhanced spermatogenesis and testosterone levels in men with NOA and severe oligospermia, especially those with hypogonadotropic profiles. The treatment was safe, well-tolerated, and achieved sperm recovery and some natural pregnancies, suggesting it as an effective and affordable option for male infertility management in resource-limited settings.
Gonadotropin therapy, human chorionic gonadotropin and follicle-stimulating hormone treatment, male infertility, non-obstructive azoospermia, severe oligospermia
Total intravenous anesthesia versus inhalational anesthesia in craniotomy: A comparative analysis
Tanjila Rahman Tannee, Md. Rabiul Islam, Jannath Ara Ferdous, Dawan Mohammad Anisur Rahman, Md. Anwarul Mamun, Md. Rayhan Reza Rony, Md. Mostafa Nawys, Asad Din Mahmood, Mohammed Mohidur Rahman
Annals of International Medical and Dental Research (AIMDR) | Vol-11, Issue- 6 | November-December 2025 | Page: 59-67
Total intravenous anesthesia versus inhalational anesthesia in craniotomy: A comparative analysis
Tanjila Rahman Tannee, Md. Rabiul Islam, Jannath Ara Ferdous, Dawan Mohammad Anisur Rahman, Md. Anwarul Mamun, Md. Rayhan Reza Rony, Md. Mostafa Nawys, Asad Din Mahmood, Mohammed Mohidur Rahman
Abstract
Background: Craniotomy requires precise anesthetic management to ensure brain relaxation, hemodynamic stability, and rapid recovery. Total intravenous anesthesia (TIVA) offers better intracranial pressure control and reduced post-operative nausea, while inhalational anesthesia allows faster emergence. This study aims to compare TIVA and inhalational anesthesia in elective supratentorial craniotomy, focusing on intraoperative stability, recovery, and post-operative outcomes.
Methods: This prospective comparative study included 100 adults undergoing elective supratentorial craniotomy, randomized to receive either TIVA with propofol–fentanyl or inhalational anesthesia with isoflurane/sevoflurane and opioids. Conducted at (study place) from (start) to (end), it enrolled American Society of Anesthesiologists I–III patients over 18 years, excluding emergencies, severe systemic disease, or drug allergies. Intraoperative hemodynamics, anesthetic use, emergence, post-operative scores, and complications were analyzed using the Statistical Package for the Social Sciences 26; P < 0.05 was considered significant.
Results: The TIVA group showed slightly better post-operative neurological recovery, with more patients maintaining higher GCS scores at 24 h. Intraoperatively, TIVA provided greater hemodynamic stability with significantly lower heart rates during induction and craniotomy. Fentanyl and vasopressor use were higher in the inhalational group. Recovery was faster in TIVA patients, with significantly shorter times to extubation, eye opening, following commands, and mobilization (P <0.001). Post-operative sedation decreased, and pain increased over time in both groups. Complication rates, including nausea, infection, seizures, and thromboembolism, were low and comparable.
Conclusion: TIVA and inhalational anesthesia are both safe for adult craniotomy. However, TIVA offers faster recovery and better early neurological outcomes, making it a suitable choice when prompt post-operative assessment is essential.
Craniotomy, inhalational anesthesia, recovery profile and hemodynamic stability, total intravenous anesthesia
Mohammed Mohidur Rahman, Tanjila Rahman Tannee, Md. Rabiul Islam, Jannath Ara Ferdous, Dawan Mohammad Anisur Rahman, Md. Anwarul Mamun, Md. Rayhan Reza Rony, Md. Mostafa Nawys, Asad Din Mahmood
Annals of International Medical and Dental Research (AIMDR) | Vol-11, Issue- 6 | November-December 2025 | Page: 68-77
Intraoperative brain relaxation strategies: Balancing intracranial pressure control and cerebral perfusion
Mohammed Mohidur Rahman, Tanjila Rahman Tannee, Md. Rabiul Islam, Jannath Ara Ferdous, Dawan Mohammad Anisur Rahman, Md. Anwarul Mamun, Md. Rayhan Reza Rony, Md. Mostafa Nawys, Asad Din Mahmood
Abstract
Background: Elective supratentorial craniotomy remains a cornerstone of neurosurgical practice, where achieving optimal intraoperative brain relaxation is crucial for surgical exposure and neurological safety. Mannitol has long been the standard osmotic agent. Hypertonic saline (HS) offers a promising alternative by reducing brain volume while maintaining intravascular volume and cerebral perfusion pressure (CPP). This study aimed to evaluate and compare two intraoperative brain relaxation strategies during elective supratentorial craniotomy.
Methods: This prospective, randomized comparative study was conducted on 80 adult patients undergoing elective supratentorial craniotomy at the Department of Neuro-Anaesthesia, Neurosciences and Hospital (NINS), Dhaka, Bangladesh, from January, 2024 to December, 2024. Participants were randomly assigned to receive either 20% mannitol (1 g/kg) or 3% HS (5 mL/kg) for intraoperative brain relaxation. Patients with renal impairment, abnormal sodium levels, uncontrolled hypertension, heart failure, or pregnancy were excluded. Standardized general anesthesia and ventilation were maintained, with cerebrospinal fluid drainage or mild hyperventilation used as adjuncts when necessary. Data were analyzed using the Statistical Package for the Social Sciences v26, and a P < 0.05 was considered statistically significant.
Results: Among 80 adult patients undergoing elective supratentorial craniotomy, satisfactory brain relaxation was achieved in 80% of those receiving HS compared with 60% in the mannitol group (P = 0.027). HS also resulted in fewer intracranial pressure (ICP) spikes ≥20 mmHg (30% vs. 50%, P = 0.012) and more consistent maintenance of CPP ≥60 mmHg (85% vs. 70%, P = 0.002). Hemodynamic stability was better with HS, though not statistically significant, while serum sodium levels were higher as expected.
Conclusion: HS achieved superior intraoperative brain relaxation compared with mannitol during elective supratentorial craniotomy, offering better control, improved cerebral perfusion, and greater hemodynamic ICP stability without increasing adverse effects. It represents an effective and safe alternative osmotherapy for optimizing surgical conditions and patient outcomes.
Cerebral perfusion pressure, Hypertonic saline, Intracranial pressure control, Intraoperative brain relaxation, Mannitol
Factors influencing the success rates of intrauterine insemination in infertile couples
Sanzida Huda, Zannatul Ferdous Jesmin, Nargis Monjura Afroz
Annals of International Medical and Dental Research (AIMDR) | Vol-11, Issue- 6 | November-December 2025 | Page: 78-82
Factors influencing the success rates of intrauterine insemination in infertile couples
Sanzida Huda, Zannatul Ferdous Jesmin, Nargis Monjura Afroz
Abstract
Introduction: Infertility affects a significant proportion of couples worldwide and poses not only medical but also psychological and social challenges. Intrauterine insemination (IUI) is a widely used first-line assisted reproductive technique for selected couples due to its simplicity, cost-effectiveness, and less invasive nature compared to in vitro fertilization. Therefore, this study aimed to evaluate the factors influencing the success rates of IUI in infertile couples attending a tertiary care hospital in Dhaka.
Methods: This prospective observational study was conducted at the Department of Obstetrics and Gynecology, Pongu and General Hospital, Khulna, Bangladesh, from March 2024 to August 2024, including 56 infertile couples undergoing IUI. Data were analyzed using the Statistical Package for the Social Sciences version 26.0.
Results: Among 56 couples undergoing IUI, the overall clinical pregnancy rate was 21.4%. Higher success rates were seen in women <35 years (31.8%), with infertility duration <5 years (28.6%), and secondary infertility (25%). Pregnancy was more likely with ≥2 preovulatory follicles (33.3%), endometrial thickness ≥8 mm (29.4%), and post-wash motile sperm count >10 million (30%).
Conclusion: This study highlights that the age of the female partner, duration of infertility, number of preovulatory follicles, endometrial thickness, and motile sperm count are significant predictors of IUI success. Higher pregnancy rates were observed in women under 35 years, with infertility duration <5 years, adequate endometrial thickness (>8 mm), multiple preovulatory follicles, and optimal post-wash sperm motility.
Infertile couples, intrauterine insemination, sperm quality, success rates
