Intrauterine insemination and controlled ovarian hyperstimulation in cycles before GIFT

Abstract

We have combined intrauterine insemination (IUI) and controlled ovarian hyperstimulation (COH), for the treatment of infertility due to different aetiologies, prior to performing GIFT. To date, we have treated 186 patients over a total of 489 cycles. The mean age of the patients was 34.1 +/- 4 years and the mean duration of infertility was 4.8 +/- 2.8 years. Follicular development was induced with human menopausal gonatrophin (HMG). Patients were monitored using serum oestradiol determinations and ovarian ultrasound. Two intrauterine inseminations were performed 12 and 36 h after HCG injection. Semen samples were prepared utilizing one of two techniques, swim-up or Percoll gradient. A total of 33 pregnancies have occurred, the gross pregnancy rate being 17.7% per patient and 6.7% per cycle. The cumulative pregnancy rate was 30%. Thirty-one pregnancies (94%) occurred within the first four cycles of treatment. During the same period of time, the pregnancy rate per cycle in patients treated with gamete intra-Fallopian transfer (GIFT) was 32.9%. Our data suggest that IUI combined with COH can result in pregnancy in a significant proportion of patients, but that the efficiency per cycle of the technique is significantly lower than GIFT.

Relationship of follicle numbers and estradiol levels to multiple implantation in 3,608 intrauterine insemination cycles

“…Concern about the risk of multiple births when OI is performed with clomiphene citrate (CC) and human menopausal gonadotropin (hMG) has existed almost since these drugs were first used (19). Recommendations to prevent multiple birth have included withholding human chorionic gonadotropin (hCG) administration when more than six follicles are Ն12 mm (11); when more than three follicles are Ն14 mm (6,21) or 16 mm (22); when more than two (23) or three (7,24) follicles are Ն18 mm; and when E 2 exceeds 400 pg/mL (25), 600 pg/mL (19), 1000 pg/mL (11,24), or 2000 pg/mL (15,26).…”

An overview of intrauterine insemination and ovulation induction

“…Martinez et al, in an extensive review of the English-language literature from 1980 to 1991, showed that there was marked variation in the results of IUI between different clinics [20]. Retrospective analyses of IUI data using life-table analysis showed a relatively constant probability of becoming pregnant after each IUI treatment through four gonadotropin IUI cycles [21] or six IUI cycles without OI [22,23], and that thereafter it is hardly increased at all by continuing for longer. Most clinicians are now agreed that further evaluation and discussion of the other treatment options available benefit of a potential increase in success rates that may be achieved, compared with natural cycle IUI, must be balanced against the increased cost of the medication and monitoring, as well as the potential complications of these medications, including ovarian hyperstimulation syndrome (OHSS) and the increased incidence of multiple pregnancies , with their associated maternal and neonatal complications [12] (see Chapters 14 and 15).…”

Inseminación intrauterina en el momento actual

“…Usando análisis de tabla de vida, un estudio retrospectivo mostró una probabilidad relativamente constante de obtener un embarazo después de cada IIU a lo largo de cuatro IIU con estimulación ovárica y hasta seis sin inducción de ovulación (17,18) , aún cuando no se recomienda la IIU sin inducción de ovulación por las menores tasas de embarazo. Después de esto, la posibilidad de incrementar las tasas de éxito es casi improbable y no se recomienda seguir intentándolo.…”