Intrauterine insemination with controlled ovarian hyperstimulation in the treatment of subfertility

Abstract

Objective: To determine the success rate of intrauterine insemination (IUI), following controlled ovarian hyperstimulation (COH) and to identify the prognostic factors associated with successful outcome in couples undergoing this form of assisted reproduction.

Design: Case series.

Place and duration of study: Concept Fertility Centre, Karachi, Pakistan from January - December 2004.

Patients and methods: A total of 290 IUI procedures carried out for the treatment of unexplained and male factor subfertility were included. The age of women ranged from 20 to 44 years and the duration of subfertility were variable. All women had tubal patency confirmed before undergoing COH with one of the three regimens. IUI was performed at follicular maturity of > 16 mm and endometrial thickness of > 7 mm. Main outcome measures analyzed were pregnancy rate per cycle of IUI, miscarriage rate and ongoing pregnancy rate. Other variables observed were the various prognostic factors associated with successful outcome in IUI, such as maternal age, effect of different regimen of COH, motile sperm count and numbers of pre-ovulatory mature follicles > 16 mm. Data was collected and entered in SPSS version 10. Chi- square test of significance was applied and p-value determined.

Results: The cycle pregnancy rate (CPR), miscarriage rate and ongoing pregnancy rate was 10%, 13.8% and 8.6% respectively. CPR was 12% in women <35 years compared to 3% in >35 years (p-value 0.03). Significant difference was not observed in the CPR with three different COH regimes. CPR increased dramatically with motile sperm count of >10 millions/ml compared with < 10 millions/ml (12.3% vs. 2.8%, p-value 0.02). Significantly higher pregnancy rate was observed with increasing number of mature follicles >16 mm (6.2%, 12.9% and 30% with one, two and three follicles, p-value 0.0019). There was no case of OHSS and only one case of twin gestation.

Conclusion: The overall CPR in patients undergoing IUI following COH at our clinic is comparable to the pregnancy rates as shown in different studies. Younger age, motile sperm count of > 10 millions/ml and two or three mature follicles >16 mm are good prognostic factors for successful outcome. However, no significant difference was observed in CPR with different COH regimes.