Decoding the effect of time interval between hCG and IUI and sperm preparation and IUI
Keywords:Case control study, IUI success, hCG trigger, Sperm processing
Background: The study was aimed to assess the difference in IUI outcome depending on the interval between hCG trigger and IUI and sperm preparation and IUI.
Methods: The study was conducted in the Department of Obstetrics and Gynecology in Infertility unit at King George’s Medical University, Lucknow from January-December 2016. All the women eligible for IUI were included in the study. Once the follicle attained size of 17-18 mm, IUI was planned 36-48 hours after Inj. hCG 10,000 IU im. Semen processing was done in laboratory and time noted between sperm preparation and IUI. Outcome was confirmation of pregnancy by urine test. Cases were women in whom IUI was done 36-40 hours after hCG as against controls (>40 hours). Interval between sperm preparation and IUI was <30 minutes in cases and ≥30 minutes in controls.
Results: A total of 624 cycles were included in the study. Clomiphene was used in 582/624 cycles (93.3%) gonadotropins used in 42/624 cycles (2.7%). There was a total of 23 conceptions in study (3.7%). Of these 8/98 (8.2%) were seen when the interval between ovulation trigger and IUI was 36-40 hours and 15/526 in cycles (2.9%) when the interval was more than 40 hours (p=0.023; OR-3.028 95% CI -1.247-7.352). Of a total of 23 conceptions in the study, 18/324 conceptions were seen when IUI was done within 30 minutes of sperm preparation as compared to 5/300 when interval was more than 30 minutes (p=0.01).
Conclusions: IUI with ovarian stimulation is a simple and effective procedure and its outcome can be maximized keeping in consideration the availability of gametes. IUI performed within 36-40 hours of hCG trigger and within 30 minutes of sperm preparation can increase conception rates.
ESHRE Capri Workshop Group. Intrauterine Insemination. Hum Reprod update. 2009;1(1):1-13.
Cantineau AE, Janssen MJ, Cohlen BJ, Allersma T. Synchronised approach for intrauterine insemination in subfertile couples. Cochrane Data Syst Rev. 2014;12:CD006942.
Kamel AM, Hussien AM, Salah E. The effect of delaying intrauterine insemination till 48 h after hCG injection on pregnancy rate. Middle East Fertil Soc J. 2015;20:290-4.
Soliman BS. Effect of time interval between human chorionic gonadotropin injection and intrauterine insemination on pregnancy rate. Middle East Fertil Soc J. 2016;21:222-7.
Gautam AN. Does the time interval between semen collection, processing and intrauterine insemination affects results of IUI. J Obstet Gynecol India. 2009;59(5):407- 9.
Alexander CJ, King J, Lipari C, Zhao Y, Wallach EE. The effect of time intervals between semen collection, processing and intrauterine insemination (IUI) on pregnancy rates in clomiphene-citrate-IUI Cycles. Fertil Steril. 2005;84:S279.
Koyun E, Okyay RE, Dogan OE, Koval M, Dogan SS, Guleki B. The effect of intrauterine insemination time on semen parameters. J Turk Ger Gynecol Assoc. 2014;15:82-5.
Rahman SM, Karmakar D, Malhotra N, Kumar S. Timing of intrauterine insemination: an attempt to unravel the enigma. Arch Gynecol Obstet. 2011;284:1023e7.
Aboul Gheit S. Pregnancy rates following three different timings of intrauterine insemination for women with unexplained infertility: a randomised controlled trial. Middle East Fertil Soc J. 2010;15:265-8.
Wang YC, Chang YC, Chen IC, Cnien HH, Wu GJ. Comparison of timing of IUI in ovarian stimulated cycles. Arch Androl. 2006;52:371-4.
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;17:213e7.
Yumusak OH, Kahyaoglu S, Pekcan MK, Isci E, Cinar M, Tasci Y. Does intrauterine insemination timing matter for achievement of pregnancy during ovulation induction by using gonadotropins? A retrospective cohort study. J Chin Med Assoc. 2017 Jun 1;80(6):366-70.
Kucuk T. Intrauterine insemination: is the timing correct? J Assist Reprod Genet. 2008;25:427-30.
Ghanem ME, Bakre NI, Emam MA, Boghdady LA, Helal AS, Elmetwally AG, et al. The effects of timing of intrauterine insemination in relation to ovulation and the number of inseminations on cycle pregnancy rate in common infertility etiologies. Human Reprod. 2011;26(3):576-83.
Kilicdag EB. The effect of intervals from sperm preparation to intra uterine insemination (IUI) time on pregnancy rate. J Turk Soc Obstet Gynecol. 2012;9(3):159-63.
Yavas Y, Selub MR. Intrauterine insemination (IUI) pregnancy outcome is enhanced by shorter intervals from semen collection to sperm preparation, from sperm preparation to IUI time, and from semen collection to IUI time. Fertil Steril. 2004;82(6):1638-47.