Comparison of intrauterine insemination and timed intercourse following controlled ovarian hyperstimulation in unexplained infertility: a randomized controlled trial

Authors

  • Sayanti Paul Department of Obstetrics and Gynecology, Himalayan Institute of Medical Science, Swami Rama Himalayan University, Dehradun, Uttarakhand, India
  • Saumen Mandal Department of Gynaecology and Obstetrics, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India
  • Arghya Pal Department of Psychiatry, Himalayan Institute of Medical Science, Swami Rama Himalayan University, Dehradun, Uttarakhand, India
  • Sumit Ranjan Pramanik Department of Gynaecology and Obstetrics, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20190876

Keywords:

Intrauterine insemination, Superovulation, Unexplained infertility

Abstract

Background: Being a diagnosis of exclusion the treatment options of unexplained infertility are often empiric. There is significant dilemma regarding the superiority of one over another. Despite increasing use of intrauterine insemination (IUI) in adjunct to controlled ovarian hyperstimulation (COH) there is scarcity of randomized controlled trials (RCT) from developing countries. Objective was to compare IUI and timed intercourse (TI) in super ovulated cycles among couples with unexplained infertility over one year.

Methods: In this prospective randomized controlled trial total 85 patients were randomly assigned into group 1 (COH with IUI, N= 44) and group 2 (COH with TI, N=41). Patients underwent COH using sequential Clomiphene Citrate and injection human menopausal gonadotrophin followed by IUI in group 1 and timed intercourse in group 2. Either protocol was repeated for three consecutive cycles. Finally, both groups were compared for clinical pregnancy rate, adverse effects and acceptability of the treatment process and outcome. Comparison was done by Student’s unpaired t test for continuous and 2-tailed chi square test for categorical variables.

Results: Clinical pregnancy rates following COH/IUI and COH/TI were 13.64% and 19.51% respectively. There was observable difference in the acceptability of the outcome (38.64% in IUI and 56.09% in TI group). All the results including complications and side effect rates were statistically insignificant.

Conclusions: Present study failed to show any improvement of pregnancy rates following addition of IUI over TI and it raised the probability that the outcome of the procedure may not be well accepted.

References

Definitions of infertility and recurrent pregnancy loss: a committee opinion. Fertil Steril. 2013;99(1):63.

Evers JLH. Female subfertility. Lancet Lond Engl. 2002;360(9327):151–9.

Wilkes S, Chinn DJ, Murdoch A, Rubin G. Epidemiology and management of infertility: a population-based study in UK primary care. Fam Pract. 2009;26(4):269–74.

Maheshwari A, Hamilton M, Bhattacharya S. Effect of female age on the diagnostic categories of infertility. Hum Reprod Oxf Engl. 2008;23(3):538-42.

Thonneau P, Marchand S, Tallec A, Ferial ML, Ducot B, Lansac J, et al. Incidence and main causes of infertility in a resident population (1,850,000) of three French regions (1988-1989). Hum Reprod Oxf Engl. 1991;6(6):811–6.

Guzick DS, Sullivan MW, Adamson GD, Cedars MI, Falk RJ, Peterson EP, et al. Efficacy of treatment for unexplained infertility. Fertil Steril. 1998;70(2):207–13.

Guzick DS, Carson SA, Coutifaris C, Overstreet JW, Factor-Litvak P, Steinkampf MP, et al. Efficacy of Superovulation and Intrauterine Insemination in the Treatment of Infertility. N Engl J Med. 1999;340(3):177-83.

National Collaborating Centre for Women’s and Children’s Health (UK). Fertility: Assessment and Treatment for People with Fertility Problems. London (UK): RCOG Press; 2004. (National Institute for Health and Clinical Excellence: Guidance). /

Stewart JA. Stimulated intra-uterine insemination is not a natural choice for the treatment of unexplained subfertility. Should the guidelines be changed? Hum Reprod Oxf Engl. 2003;18(5):903-7.

Zeyneloglu HB, Arici A, Olive DL, Duleba AJ. Comparison of intrauterine insemination with timed intercourse in superovulated cycles with gonadotropins: a meta-analysis. Fertil Steril. 1998;69(3):486-91.

Hughes EG. The effectiveness of ovulation induction and intrauterine insemination in the treatment of persistent infertility: a meta-analysis. Hum Reprod Oxf Engl. 1997;12(9):1865-72.

Martinez AR, Bernardus RE, Voorhorst FJ, Vermeiden JP, Schoemaker J. Pregnancy rates after timed intercourse or intrauterine insemination after human menopausal gonadotropin stimulation of normal ovulatory cycles: a controlled study. Fertil Steril. 1991;55(2):258-65.

Zikopoulos K, West CP, Thong PW, Kacser EM, Morrison J, Wu FC. Homologous intra-uterine insemination has no advantage over timed natural intercourse when used in combination with ovulation induction for the treatment of unexplained infertility. Hum Reprod Oxf Engl. 1993;8(4):563-7.

Veltman-Verhulst SM, Hughes E, Ayeleke RO, Cohlen BJ. Intra-uterine insemination for unexplained subfertility. Cochrane Database Syst Rev. 2016;2:CD001838.

Agarwal S, Mittal S. A randomised prospective trial of intrauterine insemination versus timed intercourse in superovulated cycles with clomiphene. Indian J Med Res. 2004;120(6):519–22.

Gregoriou O, Vitoratos N, Papadias C, Konidaris S, Gargaropoulos A, Louridas C. Controlled ovarian hyperstimulation with or without intrauterine insemination for the treatment of unexplained infertility. Int J Gynaecol Obstet Off Organ Int Fed Gynaecol Obstet. 1995;48(1):55-9.

Downloads

Published

2019-02-26

Issue

Section

Original Research Articles