Reducing day 3 baseline monitoring bloodwork and ultrasound for patients undergoing timed intercourse and intrauterine insemination treatment cycles

The clinical outcome of intrauterine insemination (IUI) treatment cycles employing a gonadotrophin-releasing hormone agonist [GnRHa, triptorelin (Decapeptyl)] or human chorionic gonadotrophin (HCG) for ovulation induction was compared. A group of 48 patients presenting with amenorrhoea, oligomenorrhoea or unexplained infertility were all treated with human menopausal gonadotrophins (HMG) from day 5 of the cycle, on an individualized schedule. They were then randomly divided into two groups to receive either a single s.c. injection of 0.1 mg triptorelin or a single i.m. injection of 10,000 IU HCG after follicular maturation. IUI was performed approximately 24 and 48 h following the injection. A transitory increase in serum luteinizing hormone and follicle stimulating hormone concentrations was achieved following injection of GnRHa. A total of 24 patients received 72 treatment cycles with GnRHa, producing 11 conceptions (15.3%) and two abortions (18.2%), resulting in a term pregnancy rate of 13.6%. There were four cases of grade 3-4 ovarian hyperstimulation syndrome (OHSS), two of which were conception cycles. In all, 24 patients underwent 68 cycles treated with HCG, producing 18 conceptions (26.5%) and six abortions (33.3%), resulting in a term pregnancy rate of 19.0%. There were eight cycles of grade 3-4 OHSS, two of which were conception cycles. These results show that an s.c. injection of a relatively low dose of GnRHa can be as effective as HCG in producing pregnancy in IUI treatment cycles.

Cetrorelix lowers premature luteinization rate in gonadotropin ovulation induction–intrauterine insemination cycles: a randomized-controlled clinical trial

Assessment of clinical pregnancies in up to eight ovarian stimulation with intrauterine insemination treatment cycles in those unable to proceed with in vitro fertilization

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 controlled ovarian stimulation (COS) with sequential clomiphene citrate and human menopausal gonadotropin. Ovulation was by i.m. HCG. At the time of insemination the occurrence of ovulation was checked by transvaginal sonography. Results: After the first treatment cycle 17 patients of group A (10.62%) and 28 patients of group B (17.50%) had ongoing pregnancies (p = 0.0413). After the second treatment cycle 12 patients of group A (8.39%) and 18 patients of group B (19.63%) had ongoing pregnancies (p = 0.0442). After the third treatment cycle 11 patients of group A (8.39%) and 14 patients of group B (12.28%) had ongoing pregnancies (p = 0.0433). After the three treatment cycles 40 patients 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.

Objective: Current information on using anti-estrogenic compounds, antioxidant vitamins and minerals in treatment of male factor infertility still remains controversial. Herein, we investigated the pregnancy outcome in male factor infertile patients using a combination of non-specific empiric modalities and Intra Uterine Insemination (IUI) procedures. Subjects and Methods: The study involved a group of 33 infertile couples with mild male factor infertility who previously failed two IUI attempts. The patients received tamoxifen, vitamin E, zinc, and selenium for three months prior to their third IUI treatment cycle. Four important parameters were mainly noted: sperm concentration, motility, forward progression and the percentage normal forms. Results: There was no difference between these parameters in semen samples of our study group in the first and second IUI treatment cycles (p<0.96, p<0.23, p<0.59, p<0.84 respectively). However, after completion of the empiric therapy course and in the third IUI treatment cycle, significant differences in overall values for the four semen parameters were detected in comparison to the earlier two IUI cycles (range p<0.005 to p<0.0005), except for semen volume and sperm normal forms, resulting in a chemical pregnancy rate of 30.3%, a clinical pregnancy rate of 21.2% and a delivery rate of 18.1%. Grouping the female patients according to the Body Mass Index (BMI) showed imperative differences in pregnancy outcome, yet there was no clear effect of age over pregnancy success rates in our study group. Conclusion: Combined empirical therapies can improve semen parameters in infertile men with mild male factor. Double insemination procedures with improved semen samples, can contribute in increasing the chances of pregnancy and life birth more significantly in females with lower BMI.

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.

Aim: To investigate the effect of empiric use of luteal phase progesterone supplementation to improve endometrial receptivity in women undergoing treatment with clomiphene citrate in combination with intrauterine insemination (CC-IUI).Design: Retrospective cohort analysis.Setting: University fertility center.Patients: 426 CC-IUI cycles from 292 patients with unexplained infertility.Interventions: Patients were treated with micronized intravaginal progesterone 100 mg twice daily beginning approximately three days after CC-IUI.Main outcome measure(s): Clinical pregnancy per initiated cycle as defined by presence of fetal heart rate on ultrasound.Results: Clinical pregnancy rate was higher in patients receiving luteal phase support compared to patients not receiving luteal phase support (odds ratio: 2.04; 95% confidence interval: 1.01–4.14) after adjusting for all factors in the analysis using a multivariate logistic regression model. Age at the start of the cycle, BMI and CC dose were not shown to have an effect on clinical pregnancy rates. Patients with endometrial lining (EML) thickness 6–8 mm and >8 mm had increased clinical pregnancy rates compared to EML <6 mm independent of luteal phase progesterone use. Patients who appear to receive the greatest benefit of progesterone supplementation are in the 6–8 mm EML cohort.Conclusions: Luteal phase progesterone supplementation in CC-IUI cycles can improve endometrial receptivity as judged by the improved clinical pregnancy rates as the primary outcome.

Subcutaneous human menopausal gonadotropin administration for controlled ovarian hyperstimulation with intrauterine insemination cycles

Efficacy and safety of intrauterine insemination in patients with moderate-to-severe endometriosis

The effectiveness of gonadotropin-releasing hormone antagonist in poor ovarian responders undergoing in vitro fertilization: a systematic review and meta-analysis

Effect of body mass index on intrauterine insemination cycle success

The aim of the present study was to assess any potential relationship between perifollicular vascularity and outcome in an in-vivo environment following human chorionic gonadotrophin (HCG) administration. A total of 182 unselected consecutive patients undergoing stimulated intrauterine insemination (IUI) cycles was recruited where the perifollicular vascularity of follicles > or =16 mm was studied using a subjective grading system and transvaginal power Doppler ultrasonography, 36 h after HCG administration. A total of 601 follicles was studied. The incidence of follicles showing high-grade perifollicular vascularity (3 and 4) was higher than those with low-grade vascularity (1 and 2) (80 versus 20%). Treatment cycles were divided according to uniformity of vascularity grades of follicles > or =16 mm on the day of IUI [55% all high (3/4) grade; 33% mixed (1/2 and 3/4) and 12% all low (1/2) grade]. The mean age and duration of subfertility were significantly higher (P < 0.05), whereas the number of follicles > or =16 mm pre/post HCG, serum oestradiol and incidence of ultrashort gonadotrophin-releasing hormone (GnRH) agonist use were all significantly lower (P < 0.05) in treatment cycles with uniformly low follicular vascularity grades compared with mixed or uniformly high-grade cycles. However, on subjecting the data to multiple logistic regression analysis, the only independent variables that affected pregnancy rates appeared to be serum oestradiol (OR 1.28, 1.01--1.62) and high-grade follicular vascularity (OR 2.41, 1.08--5.40). These data would suggest that perifollicular vascularity has an important role to play in the outcome of IUI cycles, and that power Doppler has the potential to refine the management of assisted reproduction treatment cycles.

ObjectiveTo compare success rates, associated risks and cost-effectiveness between intrauterine insemination (IUI) and in vitro fertilisation (IVF).DesignRetrospective observational study.SettingThe UK from 2012 to 2016.ParticipantsData from Human Fertilisation and Embryology Authority’s...

The objective of the study was to compare the pregnancy rates in PCOS patients undergoing clomiphene citrate (CC) and intrauterine insemination (IUI) treatment with different leading follicular sizes. A total of 358 infertile women with PCOS who underwent 563 clomiphene citrate and IUI treatment cycles were included in this prospective study. Treatment cycles were divided into three groups according to leading follicular size on the day of hCG administration: Group I: follicular size 17-18 mm (n = 177), Group II: 19-22 mm (n = 321), and Group III : >22 mm (n = 65). Pregnancy rates were evaluated. Treatment outcomes of the groups were further analyzed related to endometrial thickness measurement on the day of hCG. For this purpose, cycles were placed into three subgroups as follows: endometrial thickness <7, 8-9, and >9 mm. There was no statistically significant difference in clinical pregnancy rate per cycle between the groups (8.5, 10, and 9.2 % for Group I, II, and III, respectively, p = 0.86). In further analyses related to endometrial thickness, no significant difference was also found in pregnancy rate among the groups. This results suggest that pregnancy rate is not related to leading follicle size on the day of hCG administration in PCOS patients treated with CC and IUI. In addition, pregnancy rate in women with different follicular sizes is not influenced by the endometrial thickness.

The aim of study was to asses any potential relationship between perifollicular vascularity and fetal outcome in an invivo environment following ovarian stimulation and intrauterine insemination. A total of 75 unselected consecutive patients undergoing stimulated intrauterine insemination cycles (with clomid) was recruited where the perifollicular vascularity of the follicles ≥16 mm was studied using subjective grading system by transvaginal power Doppler ultrasonography 24 h after HCG administration. 36 hours after H.C.G administration we did intrauterine insemination and two weeks later we did pregnancy test for our patients. A total 75 mature follicles ( &gt; 16 mm ) was studied. According to the result of Doppler study we found that we had 54.6% of follicles having grade III perfollicular vascularity , 32% having grade II , and 13.3% grade I. The follicles of high grade vascularity were associated with higher pregnancy rate (grade 3= 19.5%) than cycles with low grade vascularity (grade2 =12.5%), with no pregnancy occur in grade 1 vascularity group. Early pregnancy loss rate was significantly higher in grade2 follicular vascularity (33.3%) than grade 3 (12.5%) . The mean age and duration of subfertility were significantly higher (P&lt;0.05), with low follicular vascularity grades compared with grade II, III. These data would suggest that perfollicular vascularity and PI (pulsatility index ) of uterine artery has an important role to play in the outcome of IUI cycles. And that the power Doppler has the potential to refine the management of assisted reproduction treatment cycles.