Introduction: Ovulation is the key event in Intrauterine Insemination (IUI) cycles. Monitoring ovulation prior to insemination will help to alter insemination time to improve pregnancy rate. Aim: To compare pregnancy rates and live birth rates in presence and absence of ultrasonographic features of ovulation before insemination in IUI cycles. Materials and Methods: This was a retrospective cohort study conducted in a Institute of Medical Sciences and SUM Hospital, Bhubaneswar. Three hundred eighty eight IUI cycles performed in the period of January 2017 to December 2018 were analysed. On the day of IUI prior to insemination, transvaginal ultrasonography was done 36-38 hours after ovulation trigger to document ovulation. Presumptive signs of ovulation were documented in 201 cycles (Group A) and there was no feature suggestive of ovulation in 187 cycles (Group B). In all the cycles, single insemination was performed at 38-40 hours after ovulation trigger. Baseline characteristics were compared. Mann-Whitney U test was used to compare continuous variables. Chi-square test and Fisher’s-exact test were applied to find out the differences in the categorical variables as well as the pregnancy outcomes among the groups. Pregnancy rate and live birth rate were considered as the primary outcomes. Results: Pregnancy rate (17.9% vs 18.2%, p-value=0.945) and live birth rate (17.9% vs 16.0%, p-value=0.625) were similar irrespective of ovulation status documented in ultrasonography performed before insemination. Conclusion: IUI cycle outcomes are independent of the ovulation status documented before insemination.
Objective: To compare the efficacy of clomiphene citrate and letrozole in combination with low dose human menopausal gonadotropin for controlled ovarian stimulation in intrauterine insemination (IUI) cycles.Methods: During January-2018 to December-2019 for intending 496 IUI cycles, controlled ovarian stimulation was performed with either clomiphene or letrozole combined with human menopausal gonadotropin (hMG), in two arms: subjects in one arm (Group A) were with clomiphene and hMG in 222 cycles; those in the second arm (Group B) were with letrozole and hMG in 274 cycles. Pregnancy rate and clinical pregnancy rate of both groups were considered as the primary outcomes.Results: Patient characteristics like female age, indications for IUI, type of IUI, endometrial thickness and total motile fraction (TMF) of spermatozoa of male partners were seen similar in both groups. The letrozole-hMG group (Group B) had significantly higher numbers of cycles with single dominant follicle (P=0.01) and human chorionic gonadotropin (hCG) was more frequently used as the ovulation trigger (P=0.03). Pregnancy rate (18.5% vs. 15.3%, P=0.35) and clinical pregnancy rate (18.5% vs. 15.3%, P=0.35) were similar in groups A and B, respectively.Conclusion: Clomiphene citrate and letrozole combined with low dose human menopausal gonadotropin were equally effective for controlled ovarian stimulation in IUI cycles.
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