29% Pregnancy Rate with Follicular Insemination (FI) in Women Who Could Not Ovulate 60 Hours After hCG Administration

Abstract

Objective: 1) To evaluate ultrasound as a tool to determine if the patient has ovulated. 2) To compare efficacy of Follicular Insemination (FI) and Intrauterine Insemination (IUI) in women treated with gonadotropins, who could not ovulate 60 hours after the hCG administration. Design: A prospective randomized design for the ultrasound objective and a prospective non-randomized design for the FI objective. Materials and Methods: 194 infertile women, under age of 42, without tubal factor, underwent IUI cycles. All cycles were stimulated with gonadotropins and ovulation was triggered with hCG (10.000 IU). Ultrasound 40 and 60 hours after the hCG administration determined the follicle rupture. In the group of 38 women who could not ovulate were treated by FI on the next cycles. Sperm for IUI and FI attempts was prepared by density gradient, then diluted to 4 cc. Final sperm concentration ranged between 1–18 million spermatozoa per ml. FI procedure was performed on the following fashion: 40 hours after hCG, using ultrasound guidance, an 18-gauge needle was inserted into up to three follicles injecting the sperm preparation. All patients tolerated the FI procedure after only local anesthesia. Results: On the IUI cycles, ultrasound indicated that 38 women did not ovulate and 156 ovulated. On the first group, none of them became pregnant, while 20% of women in the ovulated group became pregnant. On the FI cycles, of 38 patients and 45 cycles treated, 13 of them became pregnant. The pregnancy rates per patient and per cycle were 34% and 29%, respectively. Conclusions: 1) Ultrasound is useful to determine ovulation. 2) FI leads to high clinical pregnancy rates in patients without tubal factor, who could not ovulate after the hCG administration. 3) FI technique ensures oocyte release and gamete interaction. 4) FI is a simple office-based procedure that does not require embryologic expertise beyond sperm preparation as for IUI. 5) FI is a well tolerated ART which may be applied to women who could not ovulate 60 hours after hCG administration, currently treated with IVF.