A comparative analysis of the cycle fecundity rates associated with ovarian hyperstimulation along with IUI versus medical management in the treatment of mild to moderate oligozoospermia in males

Authors

  • Tanaya Acharyya Department of Obstetrics and Gynecology, Silchar Medical College and Hospital, Silchar, Assam, India http://orcid.org/0000-0002-1512-9806
  • Arun Paul Choudhury Department of Obstetrics and Gynecology, Silchar Medical College and Hospital, Silchar, Assam, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20210331

Keywords:

Cycle fecundity rate, Intrauterine insemination, Ovarian hyperstimulation, Male factor subfertility, Semen analysis

Abstract

Background: To compare the pregnancy rate in infertile couples with mild to moderate oligozoospermia receiving ovarian hyperstimulation and IUI, with that of medical management with CC.

Methods: A total 120 couples with males having sperm concentration between 5 to 20 million/ml, normal serum gonadotropins and testosterone, and a presumptively fertile partner were enrolled in this prospective clinical study, during the study period of 19 months, 31st January 2019 till 1st September 2020. 120 couples were divided randomly into two groups A (n=60) and B (n=60). In group A, 60 couples were subdivided equally into 3 groups, each having 20 couples. Ovarian hyperstimulation protocols with IUI were used in different subgroups in group A.  A total of 216 IUI cycles done for 60 couples. While in group B, 60 males with oligozoospermia were prescribed CC treatment 25mg/day on alternate days for 3 months.

Results: Out of 60 patients in group A, 24 achieved pregnancy with a cycle fecundity rate of 4% in CC+IUI, 9.87% in HMG+CC+IUI and 21.67% in HMG+IUI. 5 out of 60 patients in group B achieved pregnancy with cycle fecundity rate of 2.78%.

Conclusions: These data suggest that acceptable pregnancy rates can be achieved with IUI combined with ovarian hyperstimulation in males with oligozoospermia. The role of CC treatment in males with oligozoospermia in improving the pregnancy outcome is extremely mearge. Thus, owing to the cost effectiveness and non-invasive modality, IUI is preferred prior to other more invasive and potentially costly reproductive technologies in the treatment of male factor subfertility.

Author Biographies

Tanaya Acharyya, Department of Obstetrics and Gynecology, Silchar Medical College and Hospital, Silchar, Assam, India

3rd year Post Graduate Resident , Department of Obstetrics and Gynaecology, Silchar Medical College and Hospital

Arun Paul Choudhury, Department of Obstetrics and Gynecology, Silchar Medical College and Hospital, Silchar, Assam, India

Associate Professor, Department of Obstetrics and Gynaecology

References

NICE: National Institute for Health and Clinical Excellence. Fertility assessment and treatment for people with fertility problems. NICE clinical guideline. 2013:156. Available from: https://www.nice.org.uk/guidance/cg156/evidence/full-guideline-pdf-188539453. Accessed on 21 September 2020.

Practice committee of the American Society for Reproductive Medicine. Diagnostic evaluation of infertile male: A committee opinion. Fertil Steril. 2015;103(3):e18-25.

Cohlen B, Ombelet W, editors. Intra-uterine insemination: evidence based guidelines for daily practice. CRC Press; 2013:11.

Cramer DW, Walker AM, Schiff I. Statistical methods in evaluating the outcome of infertility therapy. Fertil Steril. 1979;32:80-7.

Aribarg A, Sukcharoen N. Intrauterine insemination of washed spermatozoa for treatment of oligozoospermia. Int J Androl. 1995;18(1):62-6.

Homonnai ZT, Yavetz H, Yogev L, Rotem R, Paz GF. Clomiphene citrate treatment in oligozoospermia: comparison between two regimens of low-dose treatment. Fertil Steril. 1988;50(5):801-4.

Kerin JF, Peek J, Warnes GM, Kirby C, Jeffrey R, Matthews CD, et al. Improved conception rate after intrauterine insemination of washed spermatozoa from men with poor quality semen. Lancet. 1984;323(8376):533-5.

Cruz RI, Kemmann E, Brandeis VT, Becker KA, Beck M, Beardsley L, et al. A prospective study of intrauterine insemination of processed sperm from men with oligoasthenospermia in superovulated women. Fertil Steril. 1986;46(4):673-7.

Hoing LM, Devroey P, Van Steirteghem AC. Treatment of infertility because of oligoasthenoteratospermia by transcervical intrauterine insemination of motile spermatozoa. Fertil Steril. 1986;45(3):388-91.

Horvath PM, Bohrer M, Shelden RM, Kemmann E. The relationship of sperm parameters to cycle fecundity in superovulated women undergoing intrauterine insemination. Fertil Steril. 1989;52(2):288-94.

Martinez AR, Bernardus RE, Voorhorst FJ, Vermeiden JP, Schoemaker J. Intrauterine insemination does and clomiphene citrate does not improve fecundity in couples with infertility due to male or idiopathic factors: a prospective, randomized, controlled study. Fertil steril. 1990;53(5):847-53.

Confino E, Friberg J, Dudkiewicz AB, Gleicher N. Intrauterine inseminations with washed human spermatozoa. Fertil Steril. 1986;46(1):55-60.

Dodson WC, Whitesides DB, Hughes Jr CL, Easley III HA, Haney AF. Superovulation with intrauterine insemination in the treatment of infertility: a possible alternative to gamete intrafallopian transfer and in vitro fertilization. Fertil Steril. 1987;48(3):441-5.

Rashidi BH, Gharaie M, Momeni M, Tehraninejad ES. A comparison of clomiphene citrate and sequential clomiphene citrate plus human menopausal gonadotropin for use in conjunction with intrauterine insemination. Acta Medica Iranica. 2005;43(3):187-92.

Manganiello PD, Stern JE, Stukel TA, Crow H, Brinck-Johnsen T, Weiss JE. A comparison of clomiphene citrate and human menopausal gonadotropin for use in conjunction with intrauterine insemination. Fertil Steril. 1997;68(3):405-12.

Mahani IM, Afnan M. The pregnancy rates with intrauterine insemination (IUI) in superovulated cycles employing different protocols (clomiphen citrate (CC), human menopausal gonadotropin (HMG) and HMG+ CC) and in natural ovulatory cycle. J Pak Med Assoc. 2004;54(10):503-5.

Chaffkin LM, Nulsen JC, Luciano AA, Metzger DA. A comparative analysis of the cycle fecundity rates associated with combined human menopausal gonadotropin (hMG) and intrauterine insemination (IUI) versus either hMG or IUI alone. Fertil Steril. 1991;55(2):252-7.

Sokol RZ, Steiner BS, Bustillo M, Petersen G, Swerdloff RS. A controlled comparison of the efficacy of clomiphene citrate in male infertility. Fertil Steril. 1988;49(5):865-70.

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Published

2021-01-28

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Original Research Articles