Assessment of the value of ultrasound monitoring and doubling of insemination in clomiphene citrate stimulated IUI cycles|
Hamdy Azab, Nahed Afify
Objective: To compare the results of controlled ovarian stimulation and intra-uterine insemination using 4 protocols.
Design: Prospective non randomized study.
Setting: An assisted reproduction unit in a private hospital.
Materials and methods: 91 couples with unexplained infertility and 79 couples with male subfertility. All women received clomiphene citrate 50 mg twice daily starting from the 3rd day of cycle for 5 days. Patients were classified into 4 groups. The 1st group (45 patients, 125 cycles) was monitored by transvaginal sonography. HCG was given when at least one follicle reaches a diameter of 17 mm or more. IUI was scheduled 36 hours after the HCG shot. The 2nd group (43 patients, 118 cycles) was also monitored by ultrasound and HCG was given as before, double insemination was done 20 hours and 40 hours after the HCG shot. In the 3rd group (42 patients, 112 cycles), monitoring of ovulation was done using commercial urinary LH detection kit, IUI was scheduled 24 hours after detection of LH. In the 4th group (40 patients, 108 cycles), monitoring of ovulation was done by urinary LH detection kit, double insemination was done 12 and 24 hours after detection of LH.
Main Outcome measure: Clinical pregnancy rate (PR).
Results: A total of 170 patients underwent 463 cycles with an average of 2.72 cycles per patient. The total number of pregnancies was 31 with an overall PR of 18% per patient and 7% per cycle. The overall pregnancies for groups I, II, III, and IV were 8 (18% per patient, 6% per cycle), 9 (21% per patient, 8% per cycle), 7 (17% per patient, 6% per cycle), and 7 (18% per patient, 6% per cycle), respectively. There was no statistically significant difference between any two groups. Patients with unexplained infertility and patients with infertility duration of less than 4 years had significantly higher PR than patients with male subfertility and patients of infertility duration more than 4 years respectively.
Conclusion: Clomiphene citrate (CC) stimulated IUI cycles, self monitored by urinary LH kits and employing single insemination, appear to be a simple, relatively effective and inexpensive initial management for couples with unexplained infertility or mild male factor subfertility of less than 4 years duration.