Timing Of Intrauterine Insemination Research Articles

Optimizing timing for intrauterine insemination (IUI) in donor sperm cycles: pre- versus post-ovulation insemination in natural cycles

Purpose To investigate whether pregnancy outcomes of natural cycle intrauterine insemination (IUI) with donor sperm can be improved by performing insemination after confirmation of ovulation. Methods This retrospective cohort study evaluated 751 couples undergoing 1170 cycles of artificial insemination with donor sperm (AID) in natural cycles between January 2018 and January 2021. Patients underwent AID either within 6–12 h after spontaneous luteinizing hormone (LH) surge (pre-ovulation group) or after ovulation was confirmed by ultrasound (post-ovulation group). Propensity score matching was performed to account for differences in baseline characteristics between groups. The main outcome measures of this study were clinical pregnancy rate and live birth rate. Results After propensity score matching, each group comprised 216 cycles. No significant differences were observed between the pre-ovulation and post-ovulation groups in terms of clinical pregnancy rate (30.6% vs 27.3%, respectively, p = .458) and live birth rate (25.0% vs 22.7%, respectively, p = .651). However, upon excluding cases of luteinized unruptured follicle syndrome (LUFS) from the pre-ovulation group, the clinical pregnancy rate (33.5% vs 27.3%, respectively, p = .043) and live birth rate (27.4% vs 22.7%, respectively, p = .039) were significantly higher in the pre-ovulation group. Conclusions For fertile women undergoing AID in natural cycles, pre-ovulation insemination timing yielded superior pregnancy outcomes compared to post-ovulation insemination when ovulation was achieved. However, due to the occurrence of LUFS, pre- and post-ovulation AID resulted in comparable overall pregnancy outcomes in natural cycles.

Intrauterine insemination timing models-LH can only take you so far.

Can an optimal LH threshold algorithm accurately predict timing of ovulation for natural cycle-intrauterine insemination (NC-IUI)? A retrospective cohort study (2018-2022) including 2467 natural cycles. Ovulation timing for these cycles was determined using a previously developed AI model. Two LH thresholds, low and high, were determined in the LH algorithm. Being below the low threshold meant that ovulation is likely to occur in ≥ 4days, suggesting another daily blood test. Between the two thresholds meant that ovulation was likely in 2-3days, suggesting IUI the next day. Above the high threshold meant that ovulation will likely occur tomorrow, suggesting performing IUI on the same day. The optimal LH model with a high threshold of 40 mIU/ml and a low threshold of 11 mIU/ml succeeded in correctly predicting timing for IUI (day - 1, - 2 relative to ovulation) in 75.4% (95%CI 75.3-75.4). In 23.1% (95%CI 23.0-23.2), the algorithm predicted "error," suggesting performing insemination when in fact it would have been performed on a non-optimal day (0 or - 3). A previously described 3-hormone-based (LH, estradiol, progesterone) AI model performed significantly better in all parameters (93.6% success rate, 4.3 "error" rate). An LH threshold model, representing common practice, evaluating all possible high and low LH threshold combinations, was successful in accurately scheduling timing for IUI in only 75% of cases. Integrating all three hormones as performed in the AI model may have an advantage in accurately predicting the optimal time for IUI, over the use of LH only.

Effects of a simple method for determining the time of insemination and different methods on artificial insemination in common bottlenose dolphins (Tursiops truncatus).

In this study, we examined the usefulness of a simpler and more feasible method for determining the optimal timing of artificial insemination and the conditions for its success in six female common bottlenose dolphins. Pregnancy was successfully achieved in five dolphins by performing intrauterine insemination, using chilled semen stored for less than 3 days or frozen semen within 24 hr of exhibiting a peak serum estradiol (E2) level of 100 pg/mL or higher or on the day with a serum E2 level of approximately 100 pg/mL, measured with a simple measuring device. We concluded that the determining the optimal timing of intrauterine insemination by measuring serum E2 levels is a simpler and more useful method compared with the conventional approach.

A low total motile sperm count in donor sperm obtained from commercial banks does not affect pregnancy rates from intrauterine insemination

ObjectiveWomen are often concerned about the absolute quantity and quality of sperm in a thawed donor sample at the time of intrauterine insemination (IUI). The aim of this study was to determine how the total motile sperm count (TMSC) of donor sperm obtained from commercial sperm banks affects the pregnancy rate after IUI. Study designWe performed a retrospective cohort study including single women and women in same-sex relationships undergoing IUI at a single academic fertility center between January 2011 and March 2018. Our primary outcome was pregnancy rates per IUI cycle, stratified by post-washed TMSC. The data was analyzed according to TMSC and included three different groups: samples with a TMSC less than 5 million; TMSC of 5–10 million; and a TMSC greater than 10 million. Pregnancies were defined by a serum Beta-human chorionic gonadotropin (Beta-HCG) of greater than 5 mIU/mL. Chi-squared analyses and correlation coefficients were performed. ResultsOverall, 9341 IUIs were conducted during the study period. Of these, 1080 (11.56%) were performed for single women and women in a same-sex relationship using commercially available donor sperm. We found that there were no differences in the pregnancy rates per insemination based on TMSC. The pregnancy rates per cycle were 15/114 (13.3%) for the group with a TMSC of less than 5 million; 34/351(9.5%) with a TMSC of 5–10 million; and 61/609 (10.0%) for samples with a TMSC greater than 10 million (p = 0.52). We found an insignificant correlation (r = −0.072) between donor sperm TMSC and pregnancy after IUI (p = 0.46). Furthermore, a reassuring beta-HCG level (>100IU/L) drawn 16 days after IUI was unrelated to TMSC (r = 0.0071, p = 0.94). ConclusionThe pregnancy rate following IUI is unaffected by the TMSC of commercially available donor sperm. This result is useful in reassuring patients when freshly thawed donor sperm is found to have a lower TMSC. Frozen sperm samples from commercial banks typically represent just a portion of an ejaculate produced by a donor who meets the banks’ standards for age, health and sperm quality. As such, exaggerated sperm death caused by freezing does not result in worse outcomes with donor sperm.

An Analysis of pre and post-Processing Semen Parameters at The Time of Intrauterine Insemination; and The Confounding Effects of Total Motile Sperm Counts on Pregnancy Outcome: A Prospective Cohort Study.

This study aims to determine whether pre or post-processing semen parameters obtained during intrauterine insemination (IUI) predict pregnancy when controlling for confounding effects. A prospective cohort study of 2231 semen analyses was conducted at McGill University of IVF center. Any couples who underwent IUI with partner sperm, over a 2.5-year period, were included. Controlled ovarian stimulation was done with Clomiphene Citrate, Letrozole, or Gonadotropins. Statistical analysis was performed using t tests, two types of stepwise logistic regression, and stepwise discriminant analysis. A comparison of pre and post-processing semen parameters was undertaken to determine the probability of pregnancy. There were significant differences between pregnant and non-pregnant women in post-processing concentration (P=0.043), post-processing total motile sperm count (TMSC) (P=0.049), and post-linearity (P=0.012). However, when variable out-of-the-equation logistic regression or discriminant analysis, which controls for confounding effects between variables, were used, the findings were no longer significant. It was statistically proven that when a variable in the equation logistic regression was employed, post-processing concentration (P=0.005) and post-processing TMSC (P=0.009) remained reliable predictors of pregnancy. Two of three prediction models suggested that TMSC's relationship with pregnancy is due to confounding factors. One model maintained the validity of the TMSC. While TMSC has always been studied as an important predictor of insemination pregnancies, this finding may be due to confounding effects between semen parameters and therefore requires further investigation as to this relationship.

Factors Influencing the Pregnancy Outcome of Intrauterine Insemination and Follow-up Treatment.

Many factors were reported associated with the pregnancy rate of intrauterine insemination (IUI), which played key role is still debated. The aim of this study was to explore related clinical pregnancy outcome factor in IUI cycles of non-male factor. The clinical data of 1232 IUI cycles in 690 couples experiencing infertility who attended the Reproductive Center of Jinling Hospital between July 2015 and November 2021 were retrospectively analysed. Female and male age, body mass index (BMI), anti-Müllerian hormone (AMH), male semen parameters before and after wash, endometrial thickness (EMT), artificial insemination timing and ovarian stimulation (OS) protocols were compared between the pregnant group and the non-pregnant group in order to explore any correlation. Continuous variables were analysed using independent-samples t-test, and Chi-square test was used for comparison of measurement data between the two groups. P <0.05 was considered statistical significance. There were statistically significant differences in female AMH, EMT and duration of OS between the two groups. The AMH was higher in the pregnant group than in the non-pregnant group (P < 0.01), the stimulated days was significantly longer (P < 0.05) and EMT was significantly greater (P < 0.01) in the pregnant group than in the non-pregnant group. Further analysis showed that when patients with IUI had the following conditions: AMH &gt; 4.5 ng/ml, EMT between 8 and 12 mm and letrozole + human menopausal gonadotropin stimulation with higher clinical pregnancy. However, there were no differences between the pregnant group and the non-pregnant group amongst the female and male age, BMI, hormones on baseline and day of human chorionic gonadotrophin, number of ovulated oocytes, sperm parameters before and after wash, treatment protocols and the timing of IUI (P > 0.05). Furthermore, there were 240 couples who not pregnant received one or more cycles of in vitro fertilisation/intracytoplasmic sperm injection/ pre-implantation genetic technology treatment, and another 182 couples forgo follow-up treatment. The results of the present study demonstrate that the clinical IUI pregnancy rate is correlated with the factors of female AMH, EMT and OS protocol; more studies and samples are necessary to evaluate whether other factors affect pregnancy rate.

Wet Mount Microscopy of the Vaginal Milieu Does Not Predict the Outcome of Fertility Treatments: A Cross-sectional Study.

The aim of the study was to evaluate whether vaginal dysbiosis (bacterial vaginosis [BV] or moderate/severe aerobic vaginitis [AV]/desquamative inflammatory vaginitis) in women subjected to intrauterine insemination (IUI) or in vitro fertilization/intracytoplasmic sperm injection influences the rates of pregnancy. This is a cross-sectional study involving 392 women who underwent IUI or in vitro fertilization/intracytoplasmic sperm injection at a fertility clinic. All had a slide collected for phase contrast wet mount microscopy (WMM), which was classified according to the International Society for the Study of Vulvovaginal Disease recommendations. Correlation between flora patterns and the rate of pregnancy were evaluated. There were no differences in any of the groups in terms of pregnancy rate (biochemical, clinical, at first trimester ultrasound, or live birth) after stratifying for the presence of BV, moderate or severe (ms) AV, BV and/or moderate or severe AV, cytolysis, or abnormal vaginal flora (lactobacillary grade ≥ IIb). The presence of Candida species, cocci, or bacilli morphotypes other than lactobacilli also showed no differences. The vaginal flora assessment by WMM at the time of IUI or oocyte retrieval was not predictive of the success of fertility treatments.The absence of differences may be due to intrinsic limitations of WMM (i.e., identifying only bacterial morphotypes), a positive impact of the treatments in the vaginal flora or because the sperm and embryo transfer is made directly into the uterine cavity, thus overcoming any cervical or vaginal dysbiosis disadvantage. Future studies should focus on the endometrial milieu, rather than in the vaginal and/or cervical one.

P–077 Performance of the postwash total motile sperm count as a predictor of pregnancy at the time of intrauterine insemination

Abstract Study question Is the performance of the postwash total motile sperm count a predictor of pregnancy at the time of intrauterine insemination? Summary answer The number of motile spermatozoa inseminated (NMSI) in IUI can be used to define clear range of pre /postwash sperm parameters. What is known already There is no consensus about the optimal number of motile spermatozoa inseminated (NMSI) required for a reasonable chance of pregnancy after IUI. A meta-analysis of 16 studies assessing NMSI and IUI outcomes, concluded that at cut-off levels between 0.8 and 5 million, defined as the ability to predict failure to become pregnant. The purpose of this study is to determine the range of NMSI as a predictor of success in IUI. Study design, size, duration This prospective study includes 60 patients who underwent semen analysis at an academic infertility centre (SRIHER) during the month of December 2020 and January 2021. Participants/materials, setting, methods A total of 60 infertile couples who underwent IUI at our academic centre were enrolled in our study. A detailed history and infertility work up was done before proceeding for IUI, as per the department protocol. The semen was prepared by discontinuous 2 layered density gradient method. The results were analyzed by patient factors including age, BMI, semen parameters, NMSI. The NMSI were divided into 4 groups: A (&amp;lt;1), B (1–4), C (5–9), D (&amp;gt;10). Main results and the role of chance The mean age of the infertile couples who underwent IUI was (28.2 ± 3.8) in females and (31.8 ± 3.8) in males respectively. The sperm parameters such as concentration (21.8 ± 14.8), motility (53.15 ± 13.22), morphology (2.43 ± 1.33) respectively. When the NMSI was group C (5–9 x 10 6) the pregnancy rate was 38.5% whereas the pregnancy rate was 37.5% in group D ( &amp;gt;10 x 10 6). In the other sub groups such as group A(&amp;lt;1 x 10 6) and group C (1–4 x 10 6) the pregnancy rate was 14.2% and 12.5% respectively. Limitations, reasons for caution Infertile men with Azoospermia, Men with Retrograde ejaculation, Testicular samples, Epididymal samples, Infected samples. All of the above samples were avoided. It cannot be used for counselling during the initial infertility workup, but only during/after the IUI procedure. Wider implications of the findings: The results suggest that NMSI can be a predictor of success in IUI in patients who are &amp;lt; 30 years of age &amp; ≥35 years, NMSI does not appear to be a useful. The effect of NMSI on pregnancy rate needs to evaluated on a larger scale . Trial registration number Not applicable

Different Timing of Intrauterine Insemination and Pregnancy Outcome in Patients with Unexplained Infertility: A Randomized Controlled Study

Background: In this era of rapid advancements in assisted reproductive technologies, intrauterine insemination (IUI) is still widely offered to subfertile couples, as a cheaper and less invasive treatment option before proceeding to IVF. Objective: To determine the most suitable timing of hCG administration prior to intrauterine insemination for optimizing pregnancy outcome and success rate. Patients and methods: A randomized controlled study conducted in Obstetrics and Gynecology Department, Sohag University from 30 June 2018 to 30 June 2019 and included couples with unexplained infertility. A total of 110 patients were recruited in our study, 30 patients dropped out; where 20 patients were due to inadequate stimulation, bad endometrium or more than 3 follicles were present, 6 patients did not show up for folliculometry after being given treatment and 4 patients did not show up for the procedure after being given the hCG trigger. Results: This study showed an improved pregnancy rate when IUI was performed with a time interval of 24–36 h (13 case with positive pregnancy test). Conclusion: IUI after ovulation induction can be done any time between 24 and 48 h after hCG injection without significant differences in pregnancy rates.

Different Timing of Intrauterine Insemination and Pregnancy Outcome in Patients with Unexplained Infertility: A Randomized Controlled Study

Background: In this era of rapid advancements in assisted reproductive technologies, intrauterine insemination (IUI) is still widely offered to subfertile couples, as a cheaper and less invasive treatment option before proceeding to IVF. Objective: To determine the most suitable timing of hCG administration prior to intrauterine insemination for optimizing pregnancy outcome and success rate. Patients and methods: A randomized controlled study conducted in Obstetrics and Gynecology Department, Sohag University from 30 June 2018 to 30 June 2019 and included couples with unexplained infertility. A total of 110 patients were recruited in our study, 30 patients dropped out; where 20 patients were due to inadequate stimulation, bad endometrium or more than 3 follicles were present, 6 patients did not show up for folliculometry after being given treatment and 4 patients did not show up for the procedure after being given the hCG trigger. Results: This study showed an improved pregnancy rate when IUI was performed with a time interval of 24–36 h (13 case with positive pregnancy test). Conclusion: IUI after ovulation induction can be done any time between 24 and 48 h after hCG injection without significant differences in pregnancy rates.

Is intrauterine insemination a viable treatment option for women over 43years old? An analysis by ovarian stimulation protocol and sperm source.

The aim of this study was to determine how female age at the end of the reproductive spectrum effects success of natural cycle intrauterine insemination (IUI) or IUI in combination with ovarian stimulation. We performed a retrospective cohort study of women 43years of age and older at the time of IUI in a single academic fertility center between January 2011 and March 2018. Primary outcomes were both pregnancies and live births per cycle of IUI. Data are presented as percentage or mean ± SD. Fisher exact and chi-squared analyses were performed. There were 9334 IUI cycles conducted during the study period. Of these cycles, 325 IUIs (3.5%) were for women aged 43years and over at the time of insemination (43.6 ± 0.8, range 43 to 47years). Analysis of these 325 IUI cycles revealed 5 biochemical pregnancies (1.5%) and only 1 live birth (0.3%). The pregnancy rate did not differ between IUIs using donor sperm (N = 1/49, 2.0%) compared to IUIs with partner sperm (N = 4/276, 1.4%). The pregnancy rate did not differ between IUIs with gonadotropins (N = 2/211, 0.9%), clomiphene or letrozole (N = 2/78, 2.6%), or natural cycle (N = 1/36, 2.8%). The use of intrauterine inseminations in women 43years of age and older is an ineffective treatment strategy. This is irrespective of the use of ovarian stimulation or donor sperm. Costly gonadotropin injections did not increase the chance of pregnancy nor did oral medication when compared to natural cycle IUIs.

IUI AFTER LH SURGE: HOW SOON IS TOO SOON?

Intrauterine insemination (IUI) following ovulation induction (OI) or in a natural cycle is a first line treatment for many etiologies of infertility. The timing of IUI in relation to ovulation trigger or spontaneous luteinizing hormone (LH) surge, as well as the number of IUI attempts that should be made remains a subject of debate. Many patients prefer a single IUI, whether due to expense of treatment or feasibility of making it to an office appointment on short notice. Sperm can theoretically survive in the female reproductive tract for up to 72 hours.

Relationship between the Time of Intrauterine Insemination and Pregnancy Outcome, Based on Islamic Recommendations

Background and ObjectivesIntrauterine insemination (IUI) is one of the methods of infertility treatment. When is the best time to do this assisted reproduction procedure? There are many Islamic narrations about the appropriate time for fertilization in order to give birth to a physically, mentally, and spiritually healthy child. Therefore, this study examined the relationship between the time of IUI performance and its consequences according to Islamic narrations.MethodsThe present historical cohort study was conducted at an Infertility Center affiliated with the Academic Center for Education, Culture, and Research of Qom, Iran using the medical records of patients who underwent sex selection IUI procedure from 2011 to 2015. The data were collected using a researcher-made checklist consisting of demographic characteristics, factors affecting the pregnancy outcome in terms of medicine and narrations, as well as the pregnancy outcome. The collected data were analyzed in SPSS software (version 20).ResultsThe findings indicated that the time of IUI performance based on Islamic recommendations and the pregnancy test result had a significant relationship (P=0.003). Moreover, the time of IUI based on Islamic recommendations had a significant relationship with pregnancy outcomes (P=0.023). The highest number of abortions and neonatal disorders were observed in pregnancies that had happened at the disapproved times according to the narrations (e.g., the end of the lunar month and when the moon is in Scorpio). Besides, the highest number of births of healthy infants happened when the insemination had happened at the recommended times (e.g., Thursday noon).ConclusionDue to the relationship between the time of IUI based on Islamic recommendations and the pregnancy outcome, it is recommended that IUI be performed based on Islamic recommendations and at times other than the disapproved times so that better results will be achieved in pregnancy. However, further studies are needed in this regard.

Mature Follicle Count and Multiple Gestation Risk Based on Patient Age in Intrauterine Insemination Cycles With Ovarian Stimulation.

To estimate the risk of a multiple gestation pregnancy in ovarian stimulation intrauterine insemination (IUI) cycles when stratified by patient age and mature follicle number. We conducted a retrospective cohort study at a single private practice fertility center of IUI cycles performed from 2004 to 2017. Intervention(s) were ovarian stimulation and IUI if postwash total motile sperm count was more than 8 million. Mature follicles were defined as 14 mm or more as measured on the day of ovulation trigger. Main outcomes and measures were rates of clinical pregnancy and multiple gestation. We identified 24,649 women who underwent a total of 50,473 IUI cycles. Increasing the number of mature follicles from one to five at the time of IUI in women younger than age 38 years increased the clinical pregnancy rate from 14.6% to 21.9% (adjusted odds ratio [aOR] 1.6, 95% CI 1.4-1.9), almost entirely from a marked increase in multiple gestations per cycle from 0.6% to 6.5% (aOR 9.9, 95% CI 6.9-14.2). There was little increase in singleton pregnancies per IUI (14.1-16.4%) regardless of mature follicle number. The per-pregnancy twin and higher-order multiple gestation risk significantly increased (3.9-23.3%, P<.01 and 0.2-10.6%, P<.01, respectively) when comparing one with five mature follicles present at the time of IUI (P<.01). In women younger than age 38 years with more than three follicles present, more than one quarter of all pregnancies were multiples. Similar findings occurred in women aged 38-40 years. In women older than age 40 years, up to four follicles tripled the odds of pregnancy (aOR 3.1, 95% CI 2.1-4.5) while maintaining a less than 12% risk of multiple gestation per pregnancy and a 1.0% absolute risk of multiples. Caution should be used in proceeding with IUI after ovarian stimulation when there are more than two mature follicles in women younger than age 40 years owing to the substantially increased risk of multiple gestation without an improved chance of singleton clinical pregnancy.

Comparison of pregnancy outcomes following intrauterine insemination in young women with decreased versus normal ovarian reserve

To evaluate pregnancy outcomes following intrauterine insemination (IUI) in young women with low ovarian reserve compared to age-matched controls. Retrospective cohort SETTING: Single infertility center (July 2001-August 2018) PATIENT(S): Patients <35 years of age undergoing at least one IUI cycle with a documented serum anti-Müllerian hormone (AMH) level, patent fallopian tubes, and total motile sperm count of ≥10 million at the time of IUI. None MAIN OUTCOME MEASURE(S): The primary outcome was the presence of a positive serum hCG pregnancy test (>2 mIU/mL) obtained 2 weeks after the IUI procedure. Secondary outcomes included the incidence of live birth, biochemical loss, clinical miscarriage, and ectopic pregnancy. Additionally, cumulative reproductive outcomes including up to seven IUI cycles were calculated and compared between groups. A post-hoc power calculation demonstrated that the study sample size yielded >80% power to detect a 7% difference between groups in the primary outcome. There were 3019 patients included: 370 with AMH <1.0 ng/mL and 2649 with AMH ≥1.0 ng/mL. When adjusting for IUI treatment strategy, number of dominant follicles at time of IUI and body mass index, no difference in per-cycle or cumulative reproductive outcomes was identified between patients with low AMH (<1.0 ng/mL) and normal AMH (≥1.0 ng/mL). Analyses by treatment strategy also showed no difference in reproductive outcomes. Young patients (<35 years of age) with diminished ovarian reserve conceived as often and had per-cycle and cumulative pregnancy outcomes similar to those of age-matched controls after IUI, regardless of treatment strategy.

Effects of Vaginal Misoprostol after Intrauterine Insemination IUI

Intrauterine insemination has an important role in the treatment of infertile couples. Usage of vaginal misoprostol therapy at the time of intrauterine insemination has been investigated, and its tolerability and effects on clinical pregnancy rates still questionable. To assess the effectiveness of vaginal misoprostol on some demographic characteristics and hormones level with a success rate of Intrauterine Insemination. the period of collection of patients extended from Sep. 2018 until May 2019. Eighty- one infertile couples who attended Al Nahrain University, High Institute for Diagnostic Infertility and Assisted Reproductive Technologies, and private fertility clinics were enrolled through this study. Divided into two groups, the next group received 100 μg vaginal misoprostol immediately after completion of the IUI procedure, while the control group was subjected to ordinary IUI procedure without adjunctive therapy. The mean of demographic data of body mass index, age, and duration of infertility was statistically insignificant in control, Misoprostol post- intrauterine insemination. The percentage of pregnancy rate in the control group 5.0% and it 19.5% in the Misoprostol post-intrauterine insemination group. Moreover, there are significant differences in pregnancy rates among all study groups. According to this study, there is no significant result of pregnancy occurrences correlated with, female age, male age, and body mass index, duration of infertility or type of infertility, hormone levels. Misoprostol use after intrauterine insemination has a positive impact on pregnancy outcome in the control group 5.0% and it 19.5% in Misoprostol post- intrauterine insemination group. Smaller doses (100 μg) of misoprostol can decrease side effects without affecting the outcome.

Comparison of clinical outcomes of intrauterine inseminations which performed at 36 hours versus 42 hours after hCG trigger

Amaç: İntrauterin inseminasyon (IUI), infertil çiftlerin gebelik şansını artırmak için yaygın olarak kullanılan bir işlemdir. hCG (human koryonik gonadotropin) uygulaması sonrası planlanan IUI zamanlaması pratikte 36. Saat olarak belirlenmiştir. Ancak klinik yoğunluk sebebi ile bu zamanlamada gecikmeler yaşanabilmektedir. Biz de çalışmamızda IUI’ları 36. Saate ve 42. Saate yapılan hastaların klinik sonuçlarını karşılaştırmayı amaçladık.Yöntem: Samsun Eğitim ve Araştırma Hastanesine açıklanamayan infertilite sebebi ile başvurmuş ve gonadotropin tedavisi sonrası IUI yapılmış 450 hastanın kayıtları geriye dönük incelendi. Klinikteki yoğunluk sebebi ile hCG uygulaması sonrası IUI zamanlaması 6 saat gecikmiş (42. Saat) olan hastalar ile zamanında (36. Saat) yapılmış hastaların demografik bilgileri, hormon düzeyleri, endometrium kalınlıkları, toplam folikül sayıları, β-hCG test pozitiflikleri, canlı doğum oranları ve spontan abort oranları değerlendirildi. Gruplar arası karşılaştırmalarda Student t test ve Ki-kare testi uygulandı.Bulgular: Hastaların 348’ine IUI prosedürü hCG uygulaması sonrasında 36. Saatte uygulanmışken 102’sine 42. Saatte uygulanmıştı. Gruplar arasında yaş, infertilite süresi, bazal hormon düzeyleri ve endometrial kalınlıklar açısından fark izlenmedi (p &amp;lt;0.05) (Tablo 1). IUI tedavilerinin gebelik sonuçları üzerine olan etkileri incelendiğinde gruplar arasında ovulasyon indüksiyonu sonrası elde edilen dominant folikül sayıları, β-hCG test pozitiflikleri, canlı doğum oranları ve spontan abortus oranları açısından fark görülmedi (p=0.34, p=0.12, p=0.31, p=0.25) (Tablo 2). Sonuç: hCG enjeksiyonu ile tetiklenen ovulasyonun ardından IUI zamanlaması 42. saate geciktirilen hastaların klinik gebelik oranları 36. Saatte IUI yapılanlara göre değişmemektedir.

Injection of human chorionic gonadotropin (hCG) can cause the luteinized unruptured follicle syndrome

Purpose: To demonstrate that the injection of human chorionic gonadotropin (hCG) intramuscularly for purpose of timing of an intrauterine insemination (IUI) can cause an oocyte to fail to rupture from the follicle. Materials and Methods: A 33-year-old woman sought help for infertility that seemed related to a male factor problem. The office performed IUI’s morning and evenings on weekdays but only in the morning on weekends. The timing of IUI was generally 40 to 48 hours after the initiation of the luteinizing hormone (LH) surge. When a follicle reached a minimum E2 of 200 pg/mL and an ultrasound with at least one follicle of an average of 20 mm, an injection of hCG 10,000 units I.M. was given in the evening on a Thursday or Friday, for an IUI on Saturday or Sunday. Weekday IUI’s were based on endogenous LH surge. Ultrasounds were performed on the day of IUI and the next day, if no oocyte was released. Release was considered to have occurred if shrinkage of the follicle by &gt;5 mm took place without the serum P exceeded 2 ng/dL. Results: In six natural cycles where IUI was performed Monday-Friday, the peak sera E2 levels reached 368, 334, 337, 465, 365, and 355 pg/mL. Oocyte release was confirmed in all six cycles. There were two cycles where hCG was given for weekend IUI’s. In neither cycle was oocyte release demonstrated. Leuprolide acetate also failed to cause oocyte release. Discussion: Though hCG injection and GnRH agonists can correct the luteinized unruptured follicle (LUF) syndrome, in some instances, hCG and GnRH agonists can actually cause LUF syndrome.

To Compare the Exogenous Human Chorionic Gonadotropin Trigger with Endogenous Leutinizing Hormone Surge in Ultrasound Monitored Cycles for Timing of Intrauterine Insemination in Women with Unexplained Infertility

To Compare the Exogenous Human Chorionic Gonadotropin Trigger with Endogenous Leutinizing Hormone Surge in Ultrasound Monitored Cycles for Timing of Intrauterine Insemination in Women with Unexplained Infertility

Prospective comparative trial to define the optimum time for insemination during stimulated intrauterine insemination cycles

Objectives: To determine the clinical pregnancy rate (CPR) of women who underwent clomiphene citrate (CC) and human menopausal gonadotropin ovarian stimulation (OS) followed by intrauterine insemination (IUI) at varied times after hCG ovulation triggering and to determine the appropriate IUI timing. Patients and Methods: 152 women with primary infertility secondary to male subfertility were randomly allocated into groups (I-IV) according to timing of IUI at 34-35, 35-36, 36-37, and 37-38hr after ovulation triggering. OS consisted of 5-days oral CC 100 mg once daily since day-3 of the menstrual cycle followed by daily injection of human menopausal gonadotropin 150 IU since day-8 until hCG injection. Ovulation was monitored using TVU for evident ovulation with a dominant follicle size >18 mm. IUI was repeated for three cycles and women were evaluated for clinical pregnancy rate (CPR) and abortion and multiple pregnancy rates were recorded.Results: 44 women had clinical pregnancy for a total CPR of 28.9%. CPR% /patient was 15.8%, 34.2%, 42.1% and 23.7% and CPR%/cycle was 6, 14, 20 and 11 in the four groups, respectively with significant differences in favor of group III. Three women had ectopic and six women had multiple pregnancy and five women had abortion. Statistical analyses defined high number of performed IUI cycles as significantly negative, while longer time till IUI after hCG injection as significantly positive predictor for trial success. Kaplan-Meier regression analysis defined 37 hr (95% CI: 36.5-37.5) after hCG injection as the appropriate time to get the best chance for IUI success. Conclusion: IUI after CC + GN ovarian stimulation is an appropriate policy for infertile couples secondary to male subfertility. Total motile sperm count threshold at ≥5 million gives acceptable outcome. Semen injection at 37 hr after hCG ovulation triggering gives the highest CPR.