Intra uterine insemination an experience in rural population

Abstract

Objective:1) To find out efficacy of various ovulation induction protocols in IUI 2) To find out the efficacy of IUI in treatment of infertility Method: All infertility patients of our OPD underwent a standard investigation protocol The infertility work-up included patients’ history, physical examination, conformation of ovulation by follicular monitoring, tubal patency test by diagnostic laparoscopy, and semen analysis of male partner & PCT. All women underwent a standard treatment protocol that included either natural cycle or ovulation induction to achieve superovulation by clomiphene citrate alone, or combined with gonadotrophins. Follicula monitoring using transvaginal sonography was done from D6-8 onwards and all women were given injection Human chorionic gonadotrophin 5000 U for LH surge when the dominant follicle was ≥18 mm. IUI was Performed at 18 hours and 40 hours from the time of HCG injection. Semen for IUI was prepared by the standard Swim Up technique, or by the Density Gradient method. Progesterone (Transvaginal micronized progesterone 200mg/day) for luteal phase support for 14 days following IUI was given to patients who were affording. Results: Majority of couples were having primary infertility (60.97%) Patients of secondary infertility were of 39.03% only. In our study only 11.82% patients were having multiple factors contributing to infertility. Male factor was in 42.59% of couples as against 30.34% of couples were having only anovulation as causative factor for infertility. Unexplained infertility was present in 13.82% patients only. The outcome variable for success of IUI was occurrence of pregnancy. This was defined by delay in menses associated with presence of positive pregnancy test or a detectable rise in serum beta HCG levels. In our study overall pregnancy rate per cycle was 8.01% & per couple it was 21.65%. Per cycle fecundity according to the factor responsible for infertility, the highest success rate was observed in cervical factor (33.33%). For male factor it was 7.74% and for combined factors overall it was 5.92%. Out of 152 pregnancies that occurred during study 108 had Full Term live birth of the baby (71.05% Miscarriage was there in 9.87% patients only. Only three patients had multiple pregnancies (1.97%) and one patient had ectopic pregnancy. Per cycle fecundity was little better in patients with only anovulation( 10.51%). When we compared various regimen used for ovulation induction for IUI we found that though percentage of pregnancies achieved by Low dose HMG either with (13.89%) or without Clomiohene (15.58%), pregnancy rate achieved with clomiphene alone was 7.43% . This was promising at low affordable cost. In our study, we achieved 40.13% pregnancy with second attempt and collectively with first two attempts pregnancy rate achieved was 71.71%.