Performing IUI Simultaneously with hCG Administration Does Not Compromise Pregnancy Rate: A Retrospective Cohort Study

Vichinsartvichai, Patsama; Traipak, Khanitta; Manolerttherwan, Chirawattana

Performing IUI Simultaneously with hCG Administration Does Not Compromise Pregnancy Rate: A Retrospective Cohort Study

Authors

Patsama Vichinsartvichai

Khanitta Traipak

Chirawattana Manolerttherwan

Infertility Unit, Department of Obstetrics and Gynecology, Vajira Hospital, Faculty of Medicine, Navamindradhiraj University, Bangkok, Thailand

Abstract

Background: The probability of conception occurs before ovulation in natural cycle, thus performing IUI before ovulation should not compromise the pregnancy outcomes. Methods: A retrospective cohort study was conducted at a university hospital during 2007 to 2015. The ovarian stimulation and monitoring were performed as usual. The total of 29 preovulatory IUI, and 221 postovulatory IUI couples were recruited. In postovulatory IUI, 5,000 IU of hCG was injected when dominant follicle reached 17 mm. The IUI was performed 36 to 40 hr afterward. In preovulatory IUI, hCG was injected and IUI was performed simultaneously when the dominant follicle reached the size. Data were compared using independent sample t test and Fisher’s exact test. A p-value of <0.05 was considered statistically significant. Results: The characteristics of both groups were comparable. The cumulative biochemical, clinical, and live birth rates were not different between prevulatory and postovulatory IUI groups (10.3% vs. 16.3%; p=0.407, 10.3% vs. 12.2%; p=0.77 and 10.3% vs. 11.3%; p=0.877, respectively). Conclusion: Performing IUI simultaneously with hCG administration does not compromise pregnancy rate.

Keywords

artificial insemination

Postovulatory IUI

Pregnancy rate

Preovulatory IUI

Timing of hCG

Vichinsartvichai P, Siriphadung S, Traipak K, Promrungrueng P, Manolertthewan C, Ratchanon S. The influence of women age and successfulness of intrauterine insemination (IUI) cycles. J Med Assoc Thai. 2015;98(9):833-8.

Merviel P, Heraud MH, Grenier N, Lourdel E, Sanguinet P, Copin H. Predictive factors for pregnancy after intrauterine insemination (IUI): an analysis of 1038 cycles and a review of the literature. Fertil Steril. 2010;93(1):79-88.

Azantee YW, Murad ZA, Roszaman R, Hayati MY, Norsina MA. Associated factors affecting the successful pregnancy rate of intrauterine insemination at International Islamic University Malaysia (IIUM) Fertility Centre. Med J Malaysia. 2011;66(3):195-8.

Wilcox AJ, Weinberg CR, Baird DD. Timing of sexual intercourse in relation to ovulation. Effects on the probability of conception, survival of the pregnancy, and sex of the baby. N Engl J Med. 1995;333(23):1517-21.

Aydin Y, Hassa H, Oge T, Tokgoz VY. A randomized study of simultaneous hCG administration with intrauterine insemination in stimulated cycles. Eur J Obstet Gynecol Reprod Biol. 2013;170(2):444-8.

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(2):429-32.

Järvelä IY, Tapanainen JS, Martikainen H. Improved pregnancy rate with administration of hCG after intrauterine insemination: a pilot study. Reprod Biol Endocrinol. 2010;8:18.

Mostafa MS, El Huseiny AM, Soliman BS, Mohammed MM. Effect of postponing hCG injection after intrauterine insemination on pregnancy rate. Middle East Fertil Soc J. 2014;19(3):183-6.

Propst AM, Thoppil JJ, Groll JM, Frattarelli JL, Robinson RD, Retzloff MG. A single pre-ovulatory IUI at 12 hours after hCG trigger is comparable to a traditional IUI at 36 hours. Fertil Steril. 2012;98(3):S85-S6.

Propst AM, Thoppil JJ, Groll JM, Frattarelli JL, Robinson RD, Retzloff MG. Pre-ovulatory vs. ovulatory intrauterine insemination in controlled ovarian hyperstimulation cycles. Fertil Steril. 2007;88 (Supplement 1):S172-S3.

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(11):1431-3.

Wang YC, Chang YC, Chen IC, Cnien HH, Wu GJ. Comparison of timing of IUI in ovarian stimulated cycles. Arch Androl. 2006;52(5):371-4.

Rahman SM, Karmakar D, Malhotra N, Kumar S. Timing of intrauterine insemination: an attempt to unravel the enigma. Arch Gynecol Obstet. 2011;284(4):1023-7.

World Health Organization. WHO laboratory manual for the examination and processing of human semen. 5th ed. Geneva: World Health Organization; 2010. 341 p.

Temporal relationships between ovulation and defined changes in the concentration of plasma estradiol-17 beta, luteinizing hormone, follicle-stimulating hormone, and progesterone. I. Probit analysis. World Health Organization, Task Force on Methods for the Determination of the Fertile Period, Special Programme of Research, Development and Research Training in Human Reproduction. Am J Obstet Gynecol. 1980;138(4):383-90.

Edwards RG, Steptoe PC. Control of human ovulation, fertilization and implantation. Proc R Soc Med. 1974;67(9):932-6.

Testart J, Frydman R. Minimum time lapse between luteinizing hormone surge or human chorionic gonadotropin administration and follicular rupture. Fertil Steril. 1982;37(1):50-3.

Cantineau AE, Cohlen BJ; Dutch IUI Study Group. The prevalence and influence of luteinizing hormone surges in stimulated cycles combined with intrauterine insemination during a prospective cohort study. Fertil Steril. 2007;88(1):107-12.

Martinez AR, Bernardus RE, Kucharska D, Schoemaker J. Urinary luteinizing hormone testing and prediction of ovulation in spontaneous, clomiphene citrate and human menopausal gonadotropin-stimulated cycles. A clinical evaluation. Acta Endocrinol (Copenh). 1991;124(4):357-63.

Fuh KW, Wang X, Tai A, Wong I, Norman RJ. Intrauterine insemination: effect of the temporal relationship between the luteinizing hormone surge, human chorionic gonadotrophin administration and insemination on pregnancy rates. Hum Reprod. 1997;12(10):2162-6.

Shoham Z, Jacobs HS, Insler V. Luteinizing hormone: its role, mechanism of action, and detrimental effects when hypersecreted during the follicular phase. Fertil Steril. 1993;59(6):1153-61.

Isaksson R, Tiitinen A. Obstetric outcome in patients with unexplained infertility: comparison of treatment-related and spontaneous pregnancies. Acta Obstet Gynecol Scand. 1998;77(8):849-53.

Gelbaya TA, Potdar N, Jeve YB, Nardo LG. Definition and epidemiology of unexplained infertility. Obstet Gynecol Surv. 2014;69(2):109-15.

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(2):427-33.

Dong Fl, Sun Yp, Su Yc, Guo Yh, Hu Ll, Wang F. Relationship between processed total motile sperm count of husband or donor semen and pregnancy outcome following intrauterine insemination. Syst Biol Reprod Med. 2011;57(5):251-5.

Vandekerckhove FW, 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.