Document Detail


Intrauterine insemination results in couples requiring extended semen transport time.
MedLine Citation:
PMID:  17987885     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: The purpose of the present study is to compare intrauterine insemination (IUI) pregnancy rates (PR) as a function of diagnosis and ovulation protocol utilizing an extended semen transport time. This allowed clients to conveniently collect IUI specimens in the comfort and privacy of their home. A single IUI per treatment cycle was performed. BASIC PROCEDURES: Three-hundred-ten consecutive infertilty couples having unexplained, male factor, ovulatory dysfunction, endometriosis, tubal factor or combined diagnostic factors receiving a total of 584 cycles of IUI were included. Ovulation protocols included LH surge, clomiphene citrate (CC)-hCG, CC-gonadotropins(Gn)-hCG, Gn-hCG or leuprolide acetate (L)-Gn-hCG followed 36-42 hours by a single IUI. Pregnancy rates per cycle (fecundity) and per couple (fertility) as a function of diagnosis, ovulation protocol and cycle number were evaluated. In each cycle the couples processed the specimen by adding sperm washing medium at room temperature to the specimen 30 min following collection and allowed it to incubate for two hours prior to IUI during transport. MAIN FINDINGS: Overall, fecundity was 11.8% (69/584) and fertility was 22.3% (69/310); respectively by diagnosis was: unexplained 22.6%, 38.8%; male factor 18.8%, 42.9%; ovulatory dysfunction 12.4, 22.6%; endometriosis 5.3%, 11.1%; tubal factor 7.6%,13.3%; and combined factors 9.7%, 20.0%. Unexplained vs endometriosis (P < 0.0001, P < 0.005), tubal factor (fecundity P < 0.008) and ovulatory dysfunction (fecundity P < 0.027) was statistically different. Male factor vs endometriosis (P < 0.011, P < 0.036) was significantly different. Ovulatory dysfunction vs endometriosis was significantly different (fecundity P < 0.027). Pregnancies by ovulation protocol: LH surge 4.5%,10.5%; CC-hCG 9.4%,14.9%; CC-Gn-hCG 13.7%, 23.7%; Gn-hCG 17.5%, 45.3%; L-Gn-hCG 3.5%, 6.7%. For Gn-hCG vs L-Gn-hCG (P < 0.009, P < 0.030) and LH surge (fecundity P < 0.033). CC-Gn-hCG vs CC-hCG (fertility P < 0.050) and L-Gn-hCG (P < 0.033, P < 0.034). Gn-hCG vs CC-hCG (fecundity P < 0.043). CONCLUSIONS: We conclude that IUI is effective when utilizing an extended transport time allowing most couples to collect the specimen at home and is most effective when utilizing Gn-hCG therapy. Based on our analysis, endometriosis, tubal factor and combined diagnostic categories should proceed earlier to higher level assisted reproductive technologies.
Authors:
Gary W Randall; Pickens A Gantt
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  International journal of fertility and women's medicine     Volume:  52     ISSN:  1534-892X     ISO Abbreviation:  Int J Fertil Womens Med     Publication Date:    2007 Jan-Feb
Date Detail:
Created Date:  2007-11-08     Completed Date:  2008-01-15     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9706778     Medline TA:  Int J Fertil Womens Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  28-34     Citation Subset:  IM    
Affiliation:
ETSU Quillen College of Medicine, Department of Obstetrics and Gynecology, Johnson City, Tennessee, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Chorionic Gonadotropin / therapeutic use
Clomiphene / therapeutic use
Female
Fertility Agents, Female / therapeutic use*
Humans
Infertility / therapy
Insemination, Artificial, Heterologous / methods*
Leuprolide / therapeutic use
Luteinizing Hormone / therapeutic use
Male
Ovulation Induction / methods*
Pregnancy
Pregnancy Rate*
Semen Preservation / methods*
Chemical
Reg. No./Substance:
0/Chorionic Gonadotropin; 0/Fertility Agents, Female; 53714-56-0/Leuprolide; 9002-67-9/Luteinizing Hormone; 911-45-5/Clomiphene

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