Failure of intrauterine insemination as rescue treatment in low responders with adequate HCG timing with no oocytes retrieved

Abstract

In this retrospective study, the efficiency of carrying out rescue intrauterine insemination (IUI) in low-responder patients undergoing IVF when no oocytes were retrieved after follicular aspiration and when HCG timing was adequate was analysed. A historical control group was used. Over 13 years, women undergoing IVF with failure to obtain oocytes at follicular aspiration underwent rescue IUI if the following criteria were met: adequate HCG timing; one normal tube; motile sperm count after preparation over 3 million/ml; and ultrasound visualization of one to six follicles over 13 mm. The rescue IUI was carried out 1 h after follicular aspiration. Results were compared with those of a standard IUI population (5394 cycles) in the same period. Confidence intervals were calculated using Poisson 97.5% confidence upper tail limits when no event was observed in the study sample. No pregnancies were achieved among the 54 cases who underwent rescue IUI (confidence interval: 0 to 6.8%). This pregnancy rate was lower than that observed in the general IUI population (17.5%) (relative risk, 19.2). After adjusting for age and endometriosis, the relative risk was 11.7. The rescue IUI is an inefficient procedure. Its efficacy is unlikely to exceed 7% pregnancy rate per IUI.

Two successful pregnancies achieved by converting an in vitro fertilization cycle to an intrauterine insemination cycle in five cases with documented premature ovulation

“…Another multicenter comparative study which analyzed 7176 initiated cycles also suggested that IVF should be pursued for women demonstrating two follicles, while conversion to IUI was recommended for cycles with only one follicle, if sperm and tubal parameters were favorable (3). It was also clearly demonstrated that performing IUI as a rescue treatment provided no advantage over taking no further action when no oocytes were collected during a timed follicular puncture (6). Encountering unexpected premature ovulation at the time of OPU under anesthesia is another challenge for the clinician as well as for the infertile couple; this is a totally different situation with very few treatment alternatives.…”

Aspiration of excess follicles before intrauterine insemination in high response cycles

“…Our IUI work-up has been described previously. 3,27,28 The female work-up included at least pelvic examination, blood chemistry, measurement of hormone levels (including AMH levels), HSG, and pelvic ultrasound (US). A laparoscopic study was performed when HSG findings suggested any abnormality (however minor).…”

Recommendations for good practice in ultrasound: oocyte pick up†

“…It has been reported that in 5–20% of dominant adequately sized follicles, no oocytes are retrieved (Nargund et al., 2001; Coskun et al., 2010; Coskun et al., 2011). Furthermore, poor responders may have an increased rate of impaired folliculogenesis and oocytes may have lower quality (Matorras et al., 2014) (Fig. 3).…”

“…No oocyte retrieval with high hCG levels could indicate an ectopic pregnancy (Bringer-Deutsch et al., 2010). In cases where OPU failed to recover oocytes and the administration of the medication was adequate, performing a (rescue) IUI is associated with very low pregnancy rates (<7%) and should not be carried out (Matorras et al., 2014). …”