P20.12: Double IUI (intrauterine insemination) in cases with high pre hCG perifollicular PSV for better pregnancy rates: a randomized study of 350 IUI cycles

Abstract

Objective: To assess if the patients with pre hCG high perifollicular PSV values, would benefit with a double IUI, instead of single IUI. Method: A randomized prospective study was done of 350 IUI cycles who were stimulated by either CC or rFSH (recombinant FSH) or Letrozole with rFSH and showed a pre hCG perifolliclular PSV of 15cms/sec. Single IUI was done at 36 -38 hours after hCG injection and in double IUI cases the IUI were done at 12-14 hours and 36-38 hours. Results: With CC stimulated cycles when perifollicular PSV was 15-20, single IUI gave nearly similar conception rates with both single and double IUI. With PSV 20 -25 cms/sec, double IUI showed higher conception rates than single IUI. But when was PSV > 25, conception rates were very low with single IUI than with double IUI. With rFSH cycles with PSV 15-20, conception rates were comparable with both single IUI and double IUI but with PSV > 20, the conception rates were significantly better and with PSV > 25, the pregnancy rates with single IUI were significantly low. Same was the case with letrozole + rFSH cycles. Conclusion: In all cases with PSV > 25 cms/sec on the day of hCG, a double IUI gives better pregnancy rates, but this limit lowers to PSV 20, when it is a rFSH cycle. P20.13Estimation of uterine cavity codition by three-dimensional hysterosonosalpingograpy Background: Congenital and acquired uterine anomalies are relatively often and correlate with infertility and habitual abortions. Objective: To estimate sensitivity and specificity of three-dimensional hysterosonosalpingography (3D HSSG) compared to hysteroscopy. Methods: 60 patients, divided into two groups, were included in this prospective study. In the first group, which consisted of 30 patients, estimates were done by 3D HSSG with negative contrast, and compared to findings of hysteroscopy done on the same patients. The second group, which also consisted of 30 patients, had uterine cavity estimation done by 3D HSSG with hyperechogenic contrast, and compared to finding of hysteroscopy done on these 30 women. Results: Sensitivity and specificity of 3D HSSG with negative contrast was 100% compared to hysteroscopy. Sensitivity of 3D HSSG with hyperechogenic contrast compared to hysteroscopy was 66.6% for synechiae, 94.7% for septum and 100% for other uterine anomalies, while specificity was 100% for all uterine malformations. Conclusion: Results of this study show that 3D HSSG with negative contrast is the best method for uterine cavity vizualisation, and estimation, and it presents precise and minimally invasive alternative, that provides this method to be used in routine ambulatory practice.

Ultrasound in Infertility

“…When perifollicular PSV on the day of hCG was more than 20 cm/sec, and perifollicular RI was within normal range, double IUI has given significantly higher pregnancy rates. 23 This indicates that in patients with higher perifollicular pre hCG PSV, IUI done at 12 to 14 hours has been fruitful. Fertilization of a follicle with a PSV of less than 10 cm/sec, has high chances of fertilizing into an embryo with chromosomal abnormality.…”