Effectiveness of spontaneous ovulation as monitored by urinary luteinising hormone versus induced ovulation by administration of human chorionic gonadotrophin in couples undergoing gonadotrophin‐stimulated intrauterine insemination: a randomised controlled trial

Abstract

Objective To compare effectiveness of spontaneous ovulation monitored by urinary luteinising hormone (LH) versus induced ovulation by administration of human chorionic gonadotrophin (hCG) in couples undergoing gonadotrophin-stimulated intrauterine insemination (IUI).Design Randomised controlled trial.Setting University-level infertility unit.Population Couples with unexplained infertility, mild endometriosis, mild male factor infertility and polycystic ovarian syndrome.Methods Couples were randomised to an LH group (Group A), in which urinary LH was measured daily to detect spontaneous ovulation, or an hCG group (Group B), in which urinary hCG was administered as a trigger.Main outcome measures Clinical pregnancy rate. Secondary outcomesongoing pregnancy, live birth, multiple pregnancy and miscarriage rates.Results A total of 392 couples were randomised with 196 in each arm. The clinical pregnancy rate per woman randomised was 14/ 196 (7.1%) in the LH arm versus 15/196 (7.6%) in the hCG arm (P = 0.847, which was not statistically significant). Similarly, the ongoing pregnancy rates [13/196 (6.6%) versus 14/196 (7.1%); P = 0.84] and the live birth rates [13/196 (6.6%) versus 14/196 (7.1%); P = 0.84] between the two groups did not show any significant difference. The duration of stimulation and gonadotrophin dosage also did not differ significantly between the two methods.Conclusion There was no significant difference in clinical pregnancy rates when urinary LH and hCG trigger were compared as methods to time insemination in women undergoing gonadotropin-stimulated IUI.Keywords Human chorionic gonadotrophin, intrauterine insemination, ovulation, urinary luteinising hormone.Tweetable abstract A randomised controlled study showing similar effectiveness between two different methods of timing IUI.Please cite this paper as: Thomas S, Sebastain T, Karthikeyan M, Mangalaraj AM, Aleyamma TK, Kamath MS. Effectiveness of spontaneous ovulation as monitored by urinary luteinising hormone versus induced ovulation by administration of human chorionic gonadotrophin in couples undergoing gonadotrophin-stimulated intrauterine insemination: a randomised controlled trial. BJOG 2019; 126 (S4): 58-65.

Intrauterine Insemination After Human Chorionic Gonadotropin Trigger or Luteinizing Hormone Surge

“…The work by Martinez et al 24 was excluded because of its combined timed intercourse and IUI design and the lack of reporting for precrossover outcomes in this randomized study. The study by Thomas et al 25 was excluded because they used gonadotropins for ovarian stimulation, and patients in LH monitoring group also underwent ultrasound monitoring. The study by Vahedolain et al 26 was excluded because they used ultrasound monitoring in both groups until multiple dominant follicles were observed.…”

The utility of detecting ovulation to predict success in ovulation induction and intrauterine insemination cycles — a prospective observational study

“…Ovulation induction (OI) followed by intrauterine insemination (IUI) is the first choice treatment of idiopathic infertility due to its low risk and cost-effectiveness [2]. The success of OI-IUI may vary from 8 to 20% according to maternal age, the follicular stimulation protocol, the timing of IUI, and the verification of ovulation [3]. Considering the lack of ovulation verification following OI-IUI in current clinical practice, there is doubt that a luteinised unruptured follicle, despite treatment, may limit the success of the procedure [4].…”