DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20220169

Comparative study between intrauterine insemination following preovulatory pertubation versus intrauterine insemination alone in induced ovulation cycles in infertility patients

Pranjali Dhume

Abstract


Background: To compare the efficacy of pertubation with low dose lignocaine before ovulation followed by intrauterine insemination versus intrauterine insemination alone in induced ovulation cycles in infertility patients.

Methods: Total 60 ovulation induction cycles were studied, were randomly divided in Group A and Group B of 30 cycles each. Ovulation induction was done with clomiphene citrate / gonadotrophins. Post ovulation IUI was done in both the groups. Additionally, preovulatory pertubation with low dose lignocaine diluted in balanced salt solution was done 10-12 hrs after ovulation trigger in group A. The primary outcome conception (positive urine pregnancy test) in patients were compared between two groups. The secondary outcomes, full term pregnancy, abortion, ectopic pregnancy, procedural pain, infection, haemorrhage, and long term complications were also studied and compared.

Results: Pregnancy rate was found to be slightly more in the preovulatory perturbation with low dose lignocaine and IUI group (20.6% in Group A) as compared to IUI alone group (14.7% in Group B). But the difference was not found to be statistically significant (p>0.05). The spontaneous pregnancy rates in patients with endometriosis is <5%. In the intervention group it was 37.5% in cases with endometriosis, which was encouraging. The pertubation treatment used in this study proved to be a safe treatment option without complications. Procedure was associated with mild to moderate pain in 76% patients and severe in 8.8% patients and one patient (2.9%) had syncope. Post procedure PID was noted in one patient (2.9%).

Conclusions: Preovulatory perturbation followed by IUI was associated with increased clinical pregnancy rate as compared with IUI alone in induced ovulation cycles. The efficacy was more pronounced in the patients with endometriosis. It is safe and well tolerated.


Keywords


Lignocaine, Infertility, Preovulatory perturbation, IUI, Ovulation induction

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References


Verhulst SM, Cohlen BJ, Hughes E, Te Velde E, Heineman MJ. Intrauterine insemination for unexplained subfertility. Cochrane Database Syst Rev. 2006;18:CD0018381.

Edelstam G, Sjösten A, Bjuresten K, Ek I, Wånggren K, Spira J et al. A New Rapid and Effective Method for Treatment of Unexplained Infertility. Human Reproduction. 2008;16:1153-11.

Amso, N N, Crow J, Lewin J and Shaw R W, A comparative morphological and ultrastructural study of endometrial gland and Fallopian tube epithelia at different stages of the menstrual cycle and the menopause. Hum. Reprod. 1994;9:2234-41.

Coeman, D, Belle YV and Vandenck G. Tubal ostium membranes and their relation to infertility. Fertil Steril. 1995;55:252-7.

Edelstam GAB, Sjösten ACE, Salamon CW. Pertubation with Lignocaine – a Possible New Treatment for Women with Endometriosis and Impaired Fertility. Upsala J Med Sci. 2001;106:51-8.

Verhulst SM, Cohlen BJ, Hughes E, Te Velde E, Heineman MJ. Intrauterine insemination for unexplained subfertility. Cochrane Database Syst Rev. 2006;18:CD001838.

Johnson N, Vandekerckhove P, Watson A, Lilford R, Harada T, Hughes E. Tubal flushing for subfertility. Cochrane Database Syst Rev. 2005;18:CD003718.

Rasmussen F, Lindequist S, Larsen C, Justesen P. Therapeutic effect of hysterosalpingography: oil- versus water-soluble contrast media-a randomized prospective study. Radiology. 1991;179:75-8.

Mikulska D, Kurzawa R, Rozewicka L. Morphology of in vitro sperm phagocytosis by rat peritoneal macrophages under influence of oily contrast medium (Lipiodol). Acta Eur Fertil. 1994;25:203-6.

Nugent D, Watson AJ, Killick SR, Balen AH, Rutherford AJ. A randomized controlled trial of tubal flushing with lipiodol for unexplained infertility. Fertil Steril. 2002;77:173-5.

Edelstam GA, Andersson E, Radestad A, Flam F, Gottlieb C. The effect of lignocaine on sperm phagocytosis in the peritoneal fluid from women with or without endometriosis. Hum Reprod. 1998;13:1353-45.

Edelstam GAB, Sjösten ACE, Salamon CW. Pertubation with Lignocaine – a Possible New Treatment for Women with Endometriosis and Impaired Fertility. Upsala J Med Sci. 2001;106:51-8.

Ramazzotto J, Curro FA, Paterson JA. Toxicological assessment of lidocaine in the pregnant rat. J Dent Res. 1985;64:1214-8.

Halme J, White C, Kauma S. Peritoneal macrophages from patients with endometriosis release growth factor activity in vitro. J Clin Endocrin Metab. 1988;66:1044-9.

Haney AF, Muscato JJ, Weinberg JB. Peritoneal fluid cell populations in infertility patients. Fertil Steril. 1981;35:696-8.

Halme J. Role of peritoneal inflammation in endometriosis-associated infertility. Ann NY Acad Sci. 1991;622:266-74.

Oak MK, Chantler EN, Williams CA, Elastein M. Sperm survival studies in peritoneal fluid from infertile women with endometriosis and unexplained infertility. Clin Report Fertil. 1985;3:297-303.

Suginami H, Yano K, Wantanabe K, Matsuura S. A factor inhibiting ovum capture by the oviductal fimbriae present in the endometriosis peritoneal fluid. Fertil Steril. 1986;46:1140-6.

Olive DL, Weinberg JB, Haney AF. Peritoneal macrophages and infertility: the association between cell number and pelvic pathology. Fertil Steril. 1985;44:772-7.

Roselli F, Livrea P, Jirillo E. Voltage-Gated Sodium Channel Blockers as Immunomodulators Recent Patents on CNS Drug Discovery, 2006. Bentham Science Publishers Ltd. 2006;1:83-91.

Uteshev BS, Prokopenko LG, Konoplia EN, Farmakol EK. Lidocaine as an immunomodulator in a toxic liver lesion, lignocaine appeared to have induced immunosuppressive properties in red blood cells. 1997;60(2):45-8.

Ramazzotto J, Curro FA, Paterson JA. Toxicological assessment of lidocaine in the pregnant rat. J. Dent. Res. 1985;64:1214-8.

Rasmussen F, Lindequist S, Larsen C, Justesen P. Therapeutic effect of hysterosalpingography: oil- versus water-soluble contrast media-a randomized prospective study. Radiology. 1991;179:75-8.