Comparing the Effectiveness of Doing Intra-uterine Insemination 36 and 42 Hours After Human Chorionic Gonadotropin (HCG) Injection on Pregnancy Rate: A Randomized Clinical Trial
,
Abstract
Objective: Intrauterine insemination (IUI) is an assisted conception technique that involves the deposition of a processed semen sample in the upper uterine cavity, overcoming natural barriers to sperm ascent in the female reproductive tract. Hence, we compared the results of doing intra-uterine insemination 36 and 42 hours after human chorionic gonadotropin (hCG) hormone injection to achieve clinical and chemical pregnancy rates.
Materials and methods: One hundred and sixty infertile women with unexplained infertility participated in this clinical trial. They were divided into two groups: those who underwent IUI 36 hours after hCG injection (control group), and those who underwent IUI 42 hours after hCG injection (case group). Statistical analyses were done using IBM-SPSS 25.0. and Chi-square test were used for data analysis.
Results: The percentages of clinical and chemical pregnancies were significantly higher in the 42h group compared to the other group (P = 0.038 vs. P = 0.009, respectively). There was no significant difference regarding frequency of abortion, twin and ectopic pregnancies between the two groups (P > 0.05).
Conclusion: Doing IUI 42 hours after hCG injection can significantly increase chances of fertility compared to doing it 36 hours after hCG injection.
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3. Elhddad ASA. Clinical Outcome in Intrauterine Insemination Treatment of Sub-fertile Patients in the Teaching Assistance Reproductive Technology Centre, Albayda, Libya-A prospective Study. Clin Cas Repo Rese & Trials 2018; 3: 24-32.
4. Allahbadia GN. Intrauterine insemination: Fundamentals revisited. J Obstet Gynaecol India 2017; 67: 385-92.
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insemination. Human Reproduction Update. 2009; 15: 265-77.
7. Kamel AM, Hussien AM, Salah E. The effect of delaying intrauterine insemination till 48 h after hCG injection on pregnancy rate. Middle East Fertility Society Journal 2015; 20: 290-4.
8. Matorras R, Osuna C, Exposito A, Crisol L, Pijoan JI. Recombinant FSH versus highly purified FSH in intrauterine insemination: systematic review and metaanalysis. Fertil Steril 2011; 95: 1937-42.
9. Cohlen BJ, Te Velde ER, Van Kooij RJ. Is there still a place for intra-uterine insemination as a treatment for male subfertility? A review. Int J Androl 1995; 18: 72-5.
10. Fritz MA, Speroff L. Endocrinología ginecológica clínica y esterilidad. Philadelphia: Wolters Kluwer Health, 8th ed, 2011.
11. Cheng HY, Li HY. Successful prevention of follicular rupture at 45 h after hCG and GnRHa triggering by emergent administration of indomethacin: A case report. Taiwan J Obstet Gynecol 2018; 57: 760-2.
12. Mitwally MF, Abdel-Razeq S, Casper RF. Human chorionic gonadotropin administration is associated with high pregnancy rates during ovarian stimulation and timed intercourse or intrauterine insemination. Reprod Biol Endocrinol 2004; 2: 55.
13. Dodson WC, Haney AF. Controlled ovarian hyperstimulation and intrauterine insemination for treatment of infertility. Fertil Steril 1991; 55: 457-67.
14. Weiss A, Beck-Fruchter R, Lavee M, Geslevich Y, Golan J, Ermoshkin A, et al. A randomized trial comparing time intervals from HCG trigger to intrauterine insemination for cycles utilizing GnRH antagonists. Systems Biology in Reproductive Medicine 2015; 61: 44-9.
15. Robb PA, Robins JC, Thomas MA. Timing of hCG administration does not affect pregnancy rates in couples undergoing intrauterine insemination using clomiphene citrate. J Natl Med Assoc 2004; 96: 1431-3.
16. Dehghani-Firouzabai R, Aflatoonian A, Davar R, Farid-Mojtahedi M. A comparison of pregnancy rate before and after the administration of HCG in intrauterine insemination. Arch Gynecol Obstet 2014; 289: 429-32.
17. Claman P, Wilkie V, Collins D. Timing intrauterine insemination either 33 or 39 hours after administration of human chorionic gonadotropin yields the same pregnancy rates as after superovulation therapy. Fertil Steril 2004; 82: 13-6.
18. Cantineau AEP, Janssen MJ, Cohlen BJ, Allersma T. Synchronised approach for intrauterine insemination in subfertile couples. Cochrane Database Syst Rev 2014:
(12): CD006942.
19. Soliman BS. Effect of time interval between human chorionic gonadotropin injection and intrauterine insemination on pregnancy rate. Middle East Fertility Society Journal 2016; 21: 222-7.
20. Goverde AJ, McDonnell J, Vermeiden JP, Schats R, Rutten FF, Schoemaker J. Intrauterine insemination or in-vitro fertilisation in idiopathic subfertility and male subfertility: a randomised trial and cost-effectiveness analysis. Lancet 2000; 355: 13-8.
21. 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; 340:177-83.
22. Sicchieri F, Silva AB, Silva ACJSRE, Navarro PAAS, Ferriani RA, Reis RMD. Prognostic factors in intrauterine insemination cycles. JBRA Assist Reprod. 2018; 22: 2-7.
23. Edwards R, Steptoe P. Control of Human Ovulation, Fertilization and Implantation. Proc R Soc Med 1974; 67: 932-6.
24. Testart J, Frydman R. Minimum time lapse between luteinizing hormone surge or human chorionic gonadotropin administration and follicular rupture. Fertil Steril1982; 37:50-3.
25. Farquhar CM, Liu E, Armstrong S, Arroll N, Lensen S, Brown J. Intrauterine insemination with ovarian stimulation versus expectant management for unexplained infertility (TUI): a pragmatic, open-label, randomised, controlled, two-centre trial. Lancet 2018; 391: 441-50.
26. Ghanem ME, Bakre NI, Emam MA, Al Boghdady LA, Helal AS, Elmetwally AG, et al. The effects of timing of intrauterine insemination in relation to ovulation and the number of inseminations on cycle pregnancy rate in common infertility etiologies. Hum Reprod 2011; 26: 576-83.
27. Agrawal S, Das V, Karuna, Agarwal A, Pandey A, Namrata. Decoding the effect of time interval between hCG and IUI and sperm preparation and IUI. International Journal of Reproduction, Contraception, Obstetrics and Gynecology 2018; 7:892-6.
28. AboulGheit S. Pregnancy rates following three different timings of intrauterine insemination for women with unexplained infertility: A randomised controlled trial. Middle East Fertility Society Journal 2010; 15: 265-8.
29. De Cicco S, Tagliaferri V, Selvaggi L, Romualdi D, Di Florio C, Immediata V, et al. Expectant management may reduce overtreatment in women affected by unexplained infertility confirmed by diagnostic laparoscopy. Arch Gynecol Obstet 2017; 295: 427-33.
30. Vandekerckhove FWRC, De Croo I, Gerris J, Vanden Abbeel E, De Sutter P. Sperm Chromatin Dispersion Test before Sperm Preparation is Predictive of Clinical Pregnancy in Cases of Unexplained Infertility Treated with Intrauterine Insemination and Induction with Clomiphene Citrate. Front Med (Lausanne) 2016; 3:63.
2. Mustafa M, Sharifa A, Hadi J, IIIzam E, Aliya S. Male and female infertility: causes, and management. IOSR Journal of Dental and Medical Sciences 2019; 18: 27-32.
3. Elhddad ASA. Clinical Outcome in Intrauterine Insemination Treatment of Sub-fertile Patients in the Teaching Assistance Reproductive Technology Centre, Albayda, Libya-A prospective Study. Clin Cas Repo Rese & Trials 2018; 3: 24-32.
4. Allahbadia GN. Intrauterine insemination: Fundamentals revisited. J Obstet Gynaecol India 2017; 67: 385-92.
5. Yumusak OH, Kahyaoglu S, Pekcan MK, Isci E, Cinar M, Tasci Y. Does intrauterine insemination timing matter for achieving pregnancy during ovulation induction using gonadotropins? A retrospective cohort study. J Chin Med Assoc 2017; 80: 366-70.
6. ESHRE Capri Workshop Group. Intrauterine
insemination. Human Reproduction Update. 2009; 15: 265-77.
7. Kamel AM, Hussien AM, Salah E. The effect of delaying intrauterine insemination till 48 h after hCG injection on pregnancy rate. Middle East Fertility Society Journal 2015; 20: 290-4.
8. Matorras R, Osuna C, Exposito A, Crisol L, Pijoan JI. Recombinant FSH versus highly purified FSH in intrauterine insemination: systematic review and metaanalysis. Fertil Steril 2011; 95: 1937-42.
9. Cohlen BJ, Te Velde ER, Van Kooij RJ. Is there still a place for intra-uterine insemination as a treatment for male subfertility? A review. Int J Androl 1995; 18: 72-5.
10. Fritz MA, Speroff L. Endocrinología ginecológica clínica y esterilidad. Philadelphia: Wolters Kluwer Health, 8th ed, 2011.
11. Cheng HY, Li HY. Successful prevention of follicular rupture at 45 h after hCG and GnRHa triggering by emergent administration of indomethacin: A case report. Taiwan J Obstet Gynecol 2018; 57: 760-2.
12. Mitwally MF, Abdel-Razeq S, Casper RF. Human chorionic gonadotropin administration is associated with high pregnancy rates during ovarian stimulation and timed intercourse or intrauterine insemination. Reprod Biol Endocrinol 2004; 2: 55.
13. Dodson WC, Haney AF. Controlled ovarian hyperstimulation and intrauterine insemination for treatment of infertility. Fertil Steril 1991; 55: 457-67.
14. Weiss A, Beck-Fruchter R, Lavee M, Geslevich Y, Golan J, Ermoshkin A, et al. A randomized trial comparing time intervals from HCG trigger to intrauterine insemination for cycles utilizing GnRH antagonists. Systems Biology in Reproductive Medicine 2015; 61: 44-9.
15. Robb PA, Robins JC, Thomas MA. Timing of hCG administration does not affect pregnancy rates in couples undergoing intrauterine insemination using clomiphene citrate. J Natl Med Assoc 2004; 96: 1431-3.
16. Dehghani-Firouzabai R, Aflatoonian A, Davar R, Farid-Mojtahedi M. A comparison of pregnancy rate before and after the administration of HCG in intrauterine insemination. Arch Gynecol Obstet 2014; 289: 429-32.
17. Claman P, Wilkie V, Collins D. Timing intrauterine insemination either 33 or 39 hours after administration of human chorionic gonadotropin yields the same pregnancy rates as after superovulation therapy. Fertil Steril 2004; 82: 13-6.
18. Cantineau AEP, Janssen MJ, Cohlen BJ, Allersma T. Synchronised approach for intrauterine insemination in subfertile couples. Cochrane Database Syst Rev 2014:
(12): CD006942.
19. Soliman BS. Effect of time interval between human chorionic gonadotropin injection and intrauterine insemination on pregnancy rate. Middle East Fertility Society Journal 2016; 21: 222-7.
20. Goverde AJ, McDonnell J, Vermeiden JP, Schats R, Rutten FF, Schoemaker J. Intrauterine insemination or in-vitro fertilisation in idiopathic subfertility and male subfertility: a randomised trial and cost-effectiveness analysis. Lancet 2000; 355: 13-8.
21. 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; 340:177-83.
22. Sicchieri F, Silva AB, Silva ACJSRE, Navarro PAAS, Ferriani RA, Reis RMD. Prognostic factors in intrauterine insemination cycles. JBRA Assist Reprod. 2018; 22: 2-7.
23. Edwards R, Steptoe P. Control of Human Ovulation, Fertilization and Implantation. Proc R Soc Med 1974; 67: 932-6.
24. Testart J, Frydman R. Minimum time lapse between luteinizing hormone surge or human chorionic gonadotropin administration and follicular rupture. Fertil Steril1982; 37:50-3.
25. Farquhar CM, Liu E, Armstrong S, Arroll N, Lensen S, Brown J. Intrauterine insemination with ovarian stimulation versus expectant management for unexplained infertility (TUI): a pragmatic, open-label, randomised, controlled, two-centre trial. Lancet 2018; 391: 441-50.
26. Ghanem ME, Bakre NI, Emam MA, Al Boghdady LA, Helal AS, Elmetwally AG, et al. The effects of timing of intrauterine insemination in relation to ovulation and the number of inseminations on cycle pregnancy rate in common infertility etiologies. Hum Reprod 2011; 26: 576-83.
27. Agrawal S, Das V, Karuna, Agarwal A, Pandey A, Namrata. Decoding the effect of time interval between hCG and IUI and sperm preparation and IUI. International Journal of Reproduction, Contraception, Obstetrics and Gynecology 2018; 7:892-6.
28. AboulGheit S. Pregnancy rates following three different timings of intrauterine insemination for women with unexplained infertility: A randomised controlled trial. Middle East Fertility Society Journal 2010; 15: 265-8.
29. De Cicco S, Tagliaferri V, Selvaggi L, Romualdi D, Di Florio C, Immediata V, et al. Expectant management may reduce overtreatment in women affected by unexplained infertility confirmed by diagnostic laparoscopy. Arch Gynecol Obstet 2017; 295: 427-33.
30. Vandekerckhove FWRC, De Croo I, Gerris J, Vanden Abbeel E, De Sutter P. Sperm Chromatin Dispersion Test before Sperm Preparation is Predictive of Clinical Pregnancy in Cases of Unexplained Infertility Treated with Intrauterine Insemination and Induction with Clomiphene Citrate. Front Med (Lausanne) 2016; 3:63.
| Files | ||
| Issue | Vol 14, No 3 (September 2020) | |
| Section | Original Articles | |
| DOI | https://doi.org/10.18502/jfrh.v14i3.4670 | |
| Keywords | ||
| Intra-Uterine Insemination Infertility Human Chorionic Gonadotropin Injection Time | ||
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How to Cite
1.
Firouz M, Noori N, Ghasemi M, Dashipour A, Keikha N. Comparing the Effectiveness of Doing Intra-uterine Insemination 36 and 42 Hours After Human Chorionic Gonadotropin (HCG) Injection on Pregnancy Rate: A Randomized Clinical Trial. J Family Reprod Health. 2020;14(3):173-179.
