Abstract
ObjectiveTo evaluate the impact of intrauterine insemination timing performed 24 or 36 h later following ovulation trigger on clinical pregnancy rate during ovulation induction with clomiphene citrate among infertile women was the objective of this study.MethodsThe medical records of 280 infertile patients who have underwent ovulation induction by using clomiphene citrate have been evaluated and cycle outcomes of the patients have been investigated specifically based on the timing of intrauterine insemination during the treatment cycle.ResultsThe clinical pregnancy rate of the study group based on the timing of intrauterine insemination (24 vs. 36 h following hCG trigger) was found to be similar regardless of infertility type. The cycle day of which hCG trigger has been performed was found to be significantly longer for patients who have achieved clinical pregnancy than patients who have not got pregnant following the treatment cycle. Dominant follicle diameter has not been found to affect clinical pregnancy rate during treatment cycles with clomiphene citrate.ConclusionsIn this study, intrauterine insemination timing did not affect the cycle outcomes whether the procedure has been performed 24 or 36 h later following ovulation trigger with exogenous hCG utilization. The longer period of treatment cycle during ovulation induction with clomiphene citrate resulted with higher clinical pregnancy rate. Intrauterine insemination can be done successfully at either 24 or 36 h after hCG in clomiphene citrate stimulated cycles. This will allow more flexibility and convenience for both physicians and patients, especially during weekends.
Highlights
Controlled ovarian stimulation (COS) with intrauterine insemination (IUI) is a widely used fertility treatment for couples to improve pregnancy rates with mild male factor, unexplained infertility, cervical factor, anovulation, minimal and mild endometriosis (Goverde et al 2000)
The medical records of 280 infertile patients who have demonstrated at least one patent fallopian tube on hysterosalpingography and whose partners had normal spermiogram analysis results based on World Health Organization (WHO) 2010 criteria have been reviewed after excluding patients with endometriosis, medical comorbidities and hormonal disturbances
All patients have received clomiphene citrate treatment (50–150 mg/day orally starting on 3–5 cycle day of menstruation and lasting on 7–9 cycle days of menstruation) for ovulation induction followed by one intrauterine insemination procedure performed on 24 or 36 h after ovulation trigger by exogenous 10,000 IU intramuscular urinary hCG injection upon detection of a mature follicle with ≥17 mm diameter
Summary
Controlled ovarian stimulation (COS) with intrauterine insemination (IUI) is a widely used fertility treatment for couples to improve pregnancy rates with mild male factor, unexplained infertility, cervical factor, anovulation, minimal and mild endometriosis (Goverde et al 2000). It is simple, relatively less invazive and expensive procedure than other forms of assisted reproductive technologies (Dodson and Haney 1991). Yang et al showed that intrauterine insemination can be done at any time between 1 and 48 h after hCG injection without affecting significantly pregnancy outcomes This flexibility in COH-IUI cycles provides more convenience for both patients and clinic staff, especially during weekends (Yang et al 2008). A 2010 systematic review of trials that evaluated the effectiveness of different synchronization methods in stimulated and natural cycles for IUI in subfertile couples concluded the choice should be based on hospital facilities, medical staff, convenience for the patient, costs and drop-out levels as no method was clearly superior to another (Cantineau et al 2010)
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