The effects of timing of intrauterine insemination in relation to ovulation and the number of inseminations on cycle pregnancy rate in common infertility etiologies

作者：M. E. Ghanem, Nagwa I. Bakre, Mahmoud Abdelghaffar Emam, L. Al Boghdady, Ahmed Helal, A. G. Elmetwally, M.H. Hassan, Ibrahim A Albahlol, Mustafa Mohsen El-Zayat · 发表于：Human Reproduction · 年份：2010 · DOI：10.1093/humrep/deq362 · 被引用次数：39 · 研究领域：Ovarian function and disorders、Assisted Reproductive Technology and Twin Pregnancy、Ectopic Pregnancy Diagnosis and Management

BACKGROUND: Controlled ovarian hyperstimulation with intrauterine insemination (COH/IUI) is an established tool in medically assisted conception for many infertility factors. However, the proper timing of IUI after hCG trigger and the frequency of IUI are still debated. We aimed to examine the association between the cycle pregnancy rate (CPR) and: (i) single IUI timed at 36 ± 2 h post-hCG (pre- or post-ovulation) (ii) the number of IUI (single or double) for pre-ovulatory cases both aims in male, anovulatory and unexplained infertility. METHODS: The study included a total 1146 first-stimulated cycles in infertile couples due to male factor, anovulation or unexplained infertility. Cycles were stimulated by clomiphine citrate (CC) or sequential CC-hMG or hMG and monitored by transvaginal ultrasound. When the leading follicle reached ≥ 18 mm mean diameter, 10000 IU hCG was given to trigger ovulation and IUI was timed for 36 ± 2 h later. Semen was processed and ovulation was checked at the time of IUI. Post-ovulatory cases received single IUI, while pre-ovulatory cases were sequentially randomized to receive either single or double IUI. The end-point of the cycle was CPR. RESULTS: Overall CPR in the whole cohort was 10.1%. When ovulation was present before IUI, CPR was 11.7% compared with 6.7% when ovulation was absent [OR (95% CI): 1.85 (1.12-3.06), P = 0.015]. When this OR was computed according to infertility etiology, it was 1.26 (0.52-2.95) (P = 0.82) for male factor infert...