Association between trigger-intrauterine insemination interval, ovulation trigger agent, and clinical pregnancy in intrauterine insemination cycles: a 300-case analysis

Authors

  • Aananathalakshmi B. Department of Physiology, Dhanalakshmi Srinivasan University, Janani Fertility Centre, Trichy, Tamil Nadu, India
  • Akila Vaidyanathan Janani Fertility Centre, Trichy, Tamil Nadu, India
  • Chitra Santanagopalan Janani Fertility Centre, Trichy, Tamil Nadu, India
  • Enitha Kuppuraj Janani Fertility Centre, Trichy, Tamil Nadu, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20260179

Keywords:

IUI, Ovulation trigger, Insemination interval

Abstract

Background: Intrauterine insemination (IUI) is a commonly employed first-line treatment for couples with unexplained infertility and mild male factor infertility due to its simplicity, low cost, and minimal invasiveness. Ovulation is typically induced using pharmacological triggers to allow accurate scheduling of IUI either with human chorionic gonadotropin (hCG) or gonadotropin-releasing hormone (GnRH) agonists. While insemination is commonly performed between 24 and 40 hours after the trigger, studies have reported variable pregnancy rates across different timing intervals, and no universal consensus has been established. Given these uncertainties, further evaluation of both the timing of insemination and the choice of ovulation trigger is warranted. Hence this study aims to assess how the interval between ovulation trigger and IUI influences clinical pregnancy outcomes, and to compare pregnancy rates between cycles using a GnRH agonist versus hCG as the trigger.

Methods: A retrospective analysis was conducted on 300 IUI cycles performed at Janani Fertility Centre, Trichy, Tamil Nadu. Eligible cases included couples with unexplained infertility, male partners aged 23–40 years, and female partners aged 22–38 years with bilaterally patent fallopian tubes. Cycles with abnormal semen parameters, incomplete or frozen samples, double IUI, or donor sperm use were excluded. Patients were grouped according to the interval between trigger administration and IUI: <36 hours (group A, n=70), 36–38 hours (group B, n=140), and >38 hours (group C, n=90). Trigger type was hCG (n=187) or GnRH agonist (n=113). Categorical variables were analyzed using the Chi-square test.

Results: Clinical pregnancy rates differed significantly across timing groups: group A: 8.6%, group B: 25.7%, and group C: 15.6%. The highest pregnancy rate occurred when IUI was performed 36–38 hours after the ovulation trigger. Trigger comparison showed higher pregnancy rates with hCG (25%; 47/187) than with GnRH agonist (8%; 9/113).

Conclusions: IUI performed 36–38 hours after ovulation trigger is associated with the highest likelihood of clinical pregnancy, indicating optimal synchronization of ovulation and insemination at this interval. Additionally, hCG appears more effective than GnRH agonist as a trigger for improving pregnancy outcomes in IUI cycles.

Metrics

Metrics Loading ...

References

Vander Borght M, Wyns C. Fertility and infertility: Definition and epidemiology. Clin Biochem. 2018;62:2-10. DOI: https://doi.org/10.1016/j.clinbiochem.2018.03.012

Andersen AN, Goossens V, Ferraretti AP, Bhattacharya S, Felberbaum R, de Mouzon J, et al. Assisted reproductive technology in Europe, 2004: Results generated from European registers by ESHRE. Hum Reprod. 2008;23:756-71. DOI: https://doi.org/10.1093/humrep/den014

Rahman SM, Karmakar D, Malhotra N, Kumar S. Timing of intrauterine insemination: An attempt to unravel the enigma. Arch Gynecol Obstet. 2011;284:1023-7. DOI: https://doi.org/10.1007/s00404-011-1950-6

Yumusak OH, Kahyaoglu S, Pekcan MK, Isci E, Ozyer Ş, Cicek MN, et al. Which is the best intrauterine insemination timing choice following exogenous hCG administration during ovulation induction by using clomiphene citrate treatment? A retrospective study. Springerplus. 2016;5:1307. DOI: https://doi.org/10.1186/s40064-016-2992-9

Cantineau AEP, Janssen MJ, Cohlen BJ, Allersma T. Synchronised approach for intrauterine insemination in subfertile couples. Cochrane Database Syst Rev. 2014;(12):CD006942. DOI: https://doi.org/10.1002/14651858.CD006942.pub3

Sardana D. Fertilization and Embryogenesis.. Principles Pract Assisted Reprod Technol. 2018;2:69-75. DOI: https://doi.org/10.5005/jp/books/18020_6

Kölle S. Sperm-oviduct interactions: Key factors for sperm survival and maintenance of sperm fertilizing capacity. Andrology. 2022;10(5):837-43. DOI: https://doi.org/10.1111/andr.13179

Boomsma CM, Heineman MJ, Cohlen BJ, Farquhar C. Semen preparation techniques for intrauterine insemination. Cochrane Database Syst Rev. 2007;4:CD004507. DOI: https://doi.org/10.1002/14651858.CD004507.pub3

Fauque P, Lehert P, Lamotte M, Bettahar-Lebugle K, Bailly A, Diligent C, et al. Clinical success of intrauterine insemination cycles is affected by the sperm preparation time. Fertil Steril. 2014;101:1618-23. DOI: https://doi.org/10.1016/j.fertnstert.2014.03.015

Penzias A, Bendikson K, Falcone T, Hansen K, Hill M, Jindal S, et al. Evidence-based treatments for couples with unexplained infertility: a guideline. Fertil Steril. 2020;113(2):305-22. DOI: https://doi.org/10.1016/j.fertnstert.2019.10.014

Vichinsartvichai P, Traipak K, Manolertthewan C. Performing IUI simultaneously with hCG administration does not compromise pregnancy rate: A retrospective cohort study. J Reprod Infertil. 2018;19(1):26-31.

Huang FJ, Chang SY, Lu YJ, Kung FT, Tsai MY, Wu JF. Two different timings of intrauterine insemination for non-male infertility. J Assist Reprod Genet. 2000;17(4):213-7. DOI: https://doi.org/10.1023/A:1009491817237

Wang YC, Chang YC, Chen IC, Cnien HH, Wu GJ. Comparison of timing of IUI in ovarian stimulated cycles. Arch Androl. 2006;52(5):371-4. DOI: https://doi.org/10.1080/01485010600692751

Aydin Y, Hassa H, Oge T, Tokgoz VY. A randomized study of simultaneous hCG administration with intrauterine insemination in stimulated cycles. Eur J Obstet Gynecol Reprod Biol. 2013;170(2):444-8. DOI: https://doi.org/10.1016/j.ejogrb.2013.07.022

Kucuk T. Intrauterine insemination: Is the timing correct? J Assist Reprod Genet. 2008;25(8):427-30. DOI: https://doi.org/10.1007/s10815-008-9247-9

Navarro M, Himaya E, Antaki R, Bissonnette F, Kadoch J. The hCG Timing Myth in Insemination Cycles: The Surprising Truth About Pregnancy Rates. Hum Reprod. 2025;40:deaf097. DOI: https://doi.org/10.1093/humrep/deaf097.335

Beckers NGM, Macklon NS, Eijkemans MJ, Ludwig M, Felberbaum RE, Diedrich K, et al. Nonsupplemented luteal phase characteristics after final oocyte maturation with recombinant hCG, recombinant LH, or GnRH agonist in IVF cycles with rFSH and GnRH antagonist. J Clin Endocrinol Metab. 2003;88(9):4186-92. DOI: https://doi.org/10.1210/jc.2002-021953

Yen SSC, Llerena O, Little B, Pearson OH. Disappearance rates of endogenous luteinizing hormone and chorionic gonadotropin in man. J Clin Endocrinol Metab. 1968;28(12):1763-7. DOI: https://doi.org/10.1210/jcem-28-12-1763

Cerrillo M, Rodriguez S, Mayoral M, Pacheco A, Martinez-Salazar J, Garcia-Velasco JA. Differential regulation of VEGF after final oocyte maturation with GnRH agonist versus hCG: A rationale for OHSS reduction. Fertil Steril. 2009;91(4):1526-8. DOI: https://doi.org/10.1016/j.fertnstert.2008.08.118

Halim B, Lubis HP. Dual trigger with GnRH agonist and recombinant hCG improves the outcome of intrauterine insemination. Obstet Gynecol Sci. 2022;65(2):207-14. DOI: https://doi.org/10.5468/ogs.21275

Downloads

Published

2026-01-29

How to Cite

B., A., Vaidyanathan, A., Santanagopalan, C., & Kuppuraj, E. (2026). Association between trigger-intrauterine insemination interval, ovulation trigger agent, and clinical pregnancy in intrauterine insemination cycles: a 300-case analysis. International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 15(2), 583–587. https://doi.org/10.18203/2320-1770.ijrcog20260179

Issue

Section

Original Research Articles