Abstract
Objective: 1) To compare the cycle pregnancy rate of intrauterine insemination (IUI) to that of intrauterine tuboperitoneal insemination (IUTPI) in unexplained infertility 2) To assess the effect of timing of insemination in relation to ovulation on the cycle pregnancy rate of IUI and IUTPI Design: Prospective randomized study. Main outcome measures: 1) Cycle pregnancy rate of IUI and IUTPI 2) Cycle pregnancy rate of preovulatory and postovulatory insemination Material and Methods: Two groups (A and B), each group included 160 women with unexplained primary infertility. Group A were treated by IUI and group B by IUTPI after mild controlled ovarian stimulation (mCOS) with clomiphene citrate/ human menopausal gonadotropin/human chorionic gonadotropin. At the time of insemination the occurrence of ovulation was checked by transvaginal sonography. Results: After the three treatment cycles 40 patents of group A (25%) and 60 patients of group B (37.50%) had ongoing pregnancies (p=0.033) and the overall cycle pregnancy rate of group A was 9.21% and group B 14.81% (p=0.0324). In group A the cycle pregnancy rate of preovulatory insemination was 7.20% and postovulatory 9.76% (p=0.041). In group B the cycle pregnancy rate of preovulatory insemination was 17.70% and postovulatory 13.0% (p=0.0322). Five out of 40 pregnancies (12.5%) in group A, and 4 out of 60 pregnancies (6.60%) in group B were twins (p=0.0431). Conclusion: In unexplained primary infertility IUPI had significantly higher cycle pregnancy rate than IUI. Cycle pregnancy rate of IUI was significantly higher with postovulatory than preovulatory insemination. Cycle pregnancy rate of IUTPI was significantly higher with preovulatory than postovulatory insemination.
Highlights
Main outcome measures: Cycle pregnancy rate of intrauterine insemination (IUI) and intrauterine tuboperitoneal insemination (IUTPI). Cycle pregnancy rate of preovulatory and postovulatory insemination
The rationale of IUI treatment is to increase the rate of conception in the couple of unexplained infertility by increasing the chance that maximum number of healthy sperm reaches the site of fertilization [3]
In group A 160 patients had been submitted to 434 treatment cycles with cycle pregnancy rate of 9.21%
Summary
The two groups were matched for age, body mass index (BMI) and duration of infertility They were randomized for treatment by IUI/mCOH (group A) or by IUTPI/mCOS (group B). On day 3 of the menstrual cycle serum follicle stimulating hormone (FSH) was estimated and transvaginal ultrasonography was done to exclude any abnormal uterine findings, to count the antral follicles in the ovaries and to rule out ovarian cysts prior to mCOS. Monitoring started on day 10 of the cycle and repeated every other day until the day of ovulation triggering The ovulatory human chorionic gonadotropin (HCG) {(Pregnyl , Nile pharmaceutic "Organon", Cairo, Egypt), a dose of 10000 IU} was given when mean diameter of the leading follicle reached ≥ 18 mm. There was no significant difference between the insemination motile counts (IMC) obtained from the swim-up and the two-layer gradient techniques. Statistical significance was considered when P value was
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