The Use of Ultrasound during Intrauterine Insemination in Unexplained Infertility May Improve Pregnancy Outcomes (original) (raw)
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Clinical and Experimental Obstetrics & Gynecology, 2015
This study was performed to determine the effects of ultrasound (US) guidance during intrauterine insemination (IUI) on pregnancy rate. Materials and Methods. This study is a prospective randomized controlled trial which was performed in Women's Health Research and Education Hospital, Infertility Unit. The study enrolled 130 couples who were scheduled to undergo IUI. The couples were randomized according to a computer-generated list into two groups; 1) the ultrasound-guided IUI group included 64 couples (n = 64) treated for 99 cycles 2) blind IUI group included 66 couples (n = 66) treated for 104 cycles. All women underwent controlled ovarian stimulation before IUI. The study's main measurements were pregnancy rate per cycle; pregnancy rate per woman. Results: The pregnancy rates were similar in both the ultrasound-guided (USG)(16.2%, 16/99) and non-ultrasound-guided (NUSG)(12.5%, 13/104) groups (p = 0.386). Conclusions: The present results suggest a routine ultrasound guidance during IUI is not essential as it does not increase pregnancy rates but it can be used in such cases to overwhelm some sort of difficulties.
Journal of Medical Sciences and Health, 2015
Objective: To investigate the role of trans-abdominal ultrasound (TAS) guidance in intrauterine insemination (IUI). Materials and Methods: A multicentre retrospective study was conducted at three centres in Bangalore, Karnataka from November 2012 and December 2014. 146 couples with unexplained infertility and mild male factor infertility were randomized using a computer-generated random numeric table into two groups: Group 1 who underwent TAS-guided IUI (n =73) and Group 2 who underwent classical blind IUI (n =73). 480 IUI cycles were performed for both the groups in total. Results: Of the 480 IUI cycles, 228 were carried out as TAS-guided, while 252 cycles were performed as the classical blind procedure. The difference in pregnancy rates of Group 1 and Group 2 was statistically significant (22.9 and 10.6% respectively (P = 0.00036), thereby indicating that TAS-guidance significantly improves pregnancy rates in IUI. In Group 1, 10.8% cases were difficult whereas in Group 2, 31.2% cases were difficult (P = 0.00001). Conclusion: TAS-guidance in IUI significantly improves pregnancy rates and reduces the frequency of difficult IUI.
Ultrasound-Guided Artificial Insemination: a Randomized Controlled Trial
Human …, 2009
RESULTS: The PR was 16.0% per cycle in ultrasound-guided IUI and 16.8% in the control group, no statistically significant differences being observed between the groups. The 95% confidence interval for the difference in PRs of 0.8% was 8.8 to 10. There were no differences in PR ...
Clinical and Experimental Reproductive Medicine, 2019
Objective: The primary objective of this study was to compare clinical pregnancy rates in intrauterine insemination (IUI) treatment cycles with transabdominal ultrasound guidance during intrauterine catheter insemination (US-IUI) versus the "blind method" IUI without ultrasound guidance (BM-IUI). The secondary objective was to compare whether US-IUI had better patient tolerability and whether US-IUI made the insemination procedure easier for the clinician to perform compared to BM-IUI. Methods: This was a randomized controlled trial done at the Reproductive Medicine Unit of General Hospital Kuala Lumpur, Malaysia. We included women aged between 25 and 40 years who underwent an IUI treatment cycle with follicle-stimulating hormone injections for controlled ovarian stimulation. Results: A total of 130 patients were recruited for our study. The US-IUI group had 70 patients and the BM-IUI group had 60 patients. The clinical pregnancy rate was 10% in both groups (p> 0.995) and there were no significant difference between the groups for patient tolerability assessed by scores on a pain visual analog scale (p = 0.175) or level of difficulty for the clinician (p > 0.995). The multivariate analysis further showed no significant increase in the clinical pregnancy rate (adjusted odds ratio, 1.07; 95% confidence interval, 0.85-1.34; p= 0.558) in the US-IUI group compared to the BM-IUI group even after adjusting for potential covariates. Conclusion: The conventional blind method for intrauterine catheter insemination is recommended for patients undergoing IUI treatment. The use of ultrasound during the insemination procedure increased the need for trained personnel to perform ultrasonography and increased the cost, but added no extra benefits for patients or clinicians.
Factors predicting the outcome of intrauterine insemination
The Medical Journal of Basrah University, 2012
Background: Intrauterine insemination (IUI) is a frequently indicated therapeutic modality in infertility and considered to be of low to moderate complexity before the application of more sophisticated assisted reproductive technologies (ART). It is simple and inexpensive treatment in which processed and concentrated motile sperm are placed directly into uterine cavity. IUI is used together with various controlled ovarian hyperstimulation (COH) protocols for many indications such as male infertility, ovulatory disorders, endometriosis and unexplained infertility. Aim of study: Is to identify the important prognostic variables contributing to the successful outcome. Patients and methods: A prospective study was carried out at Assisted Conception Unit of Basra Medical College, A total of 203 cycles were analyzed to identify prognostic factors regarding treatment outcome. The variables selected for analysis were female age, duration and etiology of infertility, sperm parameters, number of preovulatory follicles, and number of previous treatment cycles and the method of COH. Results: The overall pregnancy rate per cycle was 9.3% (19/203). Of 19 pregnancies, 68.4% resulted in live birth, 26.3% in spontaneous abortion, and 5.3% were ectopic pregnancy. The multiple pregnancy rate was 15.8 % (3 twin pregnancies). Three significant variables for successful outcome were total motile sperm count (>10x10 6), the method of ovarian stimulation (use of r-FSH alone being superior to Clomiphen Citrate (CC) with r-FSH and CC alone), and multifollicular response. There was a tendency to a higher pregnancy rate in women <40 years and shorter duration of infertility (< 5 years) but this did not reach a statistical significance. Significant difference was not observed among different etiologies, although lowest pregnancy rate was found in unexplained infertility group. Conclusion: IUI may be an option for a selected group of couples prior to considering more sophisticated and expensive assisted reproductive techniques. High total motile sperm count (>10x10 6), controlled ovarian hyperstimulation (COH) with r-FSH and multifollicular response are valuable predictors for pregnancy in COH-IUI cycle.
Obstetrics and gynecology international, 2009
Objective. There is an asymmetric allocation of technology and other resources for infertility services. Intrauterine insemination (IUI) is a process of placing washed spermatozoa transcervically into the uterine cavity for treatment of infertility. This is a review of literature for the potential use of IUI as a basic infertility treatment in technology-limited settings. Study design. Review of articles on treatment of infertility using IUI. Results. Aspects regarding the use of IUI are reviewed, including ovarian stimulation, semen parameters associated with good outcomes, methods of sperm preparation, timing of IUI, and number of inseminations. Implications of the finding in light of the needs of low-technology medical settings are summarized. Conclusion. The reviewed evidence suggests that IUI is less expensive, less invasive, and comparably effective for selected patients as a first-line treatment for couples with unexplained or male factor infertility. Those couples may be off...
Evaluation of Role of Intrauterine Insemination in Infertility in a Tertiary Care Hospital
The last few decades have witnessed a tremendous progress in the treatment of infertility. Intrauterine insemination (IUI) is such a technique in which the washed sperm is introduced in the uterine cavity in proper time IUI may be done using husband’s semen (IUI-H) or donor’s semen (IUI-D). The rationale of IUI is to overcome vaginal acidic pH, cervical mucus hostility and to deposit adequate number of highly motile and morphologically normal sperms near the fundal region of the uterus around the expected time of ovulation. This very study was targeted to evaluate the success rate of IUI using husband’s semen (IUI-H) in terms of clinical pregnancies in infertile couples and to establish its role in the management of infertility. AIMS AND OBJECTIVES: To evaluate the pregnancy rate per cycle of IUI and also the associated prognostic factors and adverse effects, if any. MATERIALS AND METHODS : In a prospective observational longitudinal study carried out over one year (from 1st June, 2011 to 31st May, 2012) in the Department of Obstetrics and Gynaecology, Eden Hospital, Medical College, Kolkata., total 53 couples fulfilling the inclusion criteria and exempted from the exclusion criteria were included. We included infertile couples with women in the age of 20-40 years, having anatomic defects of vagina or cervix, sexual dysfunction, minimum to mild endometriosis (AFS score ≤15), and chronic anovulatory menstrual cycles; male partners with anatomic defects of penis like hypospadius, semen volume in excess or deficit, sexual dysfunction, mild & moderate oligozoospermia, mild asthenozoospermia and mild teratozoospermia; and couples with unexplained infertility. Excluded were the women with bilateral tubal blockage, pelvic tuberculosis and severe pelvic endometriosis; male partners with azoospermia, severe oligoasthenoteratozoospermia, retrograde ejaculation and anejaculation and erectile dysfunction. After obtaining “Institutional Ethical Committee” clearance, and informed consent from each of them, history taking, baseline investigations including serology and basic infertility work up (semen analysis, ultrasonography, tubal patency test, hormonal evaluation) were done in each case. After ovulation induction serial folliculometry, single IUI, per cycle, was performed using husband’s washed sperms 36 hour after hCG triggering. Maximum 6 cycles of IUI were performed in each couple. The outcome was noted in terms of clinical pregnancy. Thus total 143 IUI cycles were performed in 53 couples in the study. RESULTS: Out of total 143 IUI cycles conducted in 53 infertile couples, 14 cycles were successful in terms of confirmed pregnancy. The cycle fecundability, i.e., the pregnancy rate per cycle of IUI was 9.79%. The pregnancy rate per couple was 26.42%. Out of these 14 pregnancies, one woman (7.14%) had spontaneous abortion in 10th week of gestation. Total 8 pregnancies were reported to have ended in live birth, of which 5 was term delivery. At the time of end of this study, 5 women were continuing pregnancies. Thus live birth rate per cycle of IUI, i.e., cycle fecundity was at least 5.59%. The success of IUI depended on the number of cycles performed on a couple (maximum after 3rd cycle and no pregnancy reported after 6th cycle), the age of both of the partners (particularly the woman), duration and type of infertility, initial seminal parameters,drugs used in COH, IMSC (inseminating motile sperm count), number and size of developing follicle sand endometrial thickness. Complications of IUI were mostly mild, commonest being pain. Mild OHSS occurred in 22.30% cycles and multiple pregnancy in only one cycle. However, medical and obstetric complications (diabetes, hypertension, ante-partum haemorrhage, preterm labour, IUGR) were not uncommon in pregnancies after IUI. But, no congenital anomaly was reported till the end of this study. DISCUSSION: IUI should be considered as cost-effective therapy for infertile couples in suitable cases. Our study supported the findings of different authors regarding cycle fecundability, fecundity, determinants of successful IUI and prognostic factors. There is little rationale to continue IUI beyond 6 cycles. Most of the complications were few and IUI does not increase the chance of congenital anomaly of the offspring. CONCLUSION: IUI should be considered as effective treatment option for many unfortunate infertile couples who attend Govt. hospitals and cannot afford costly treatments like IVF. Proper case selection is important before this mode of therapy and needs proper pre-treatment evaluation of the couples. KEYWORDS: Intrauterine insemination, unexplained infertility, male subfertility, ovarian hyperstimulation syndrome.
State-Of-The-Art Ultrasound in the Management of the Infertile Couple
World journal of gynecology & womens health, 2020
Ultrasound is vital tool for imaging women and men with infertility as it is inexpensive, accessible and non-invasive, providing crucial information to allow quick diagnosis. It also helps to facilitate an interactive discussion with the patient where findings can instantly be seen and acted upon. Additionally, US is indispensable for assisting IVF and ICSI treatment especially with the introduction of 3D technology ensuring the best quality oocytes are used to strive for the best outcomes. The diagnosis and treatment of infertility can be extremely distressing for patients and we must ensure we provide the highest level of care with the use of US playing a key role in management. Furthermore, all contemporary trainees aspiring for a career in reproductive medicine should be trained and competent in advanced ultrasound.
Journal of Assisted Reproduction and Genetics, 2000
Purpose: To evaluate whether a simplified infertilityinvestigation protocol, focusing on the use of hysterocontrastsonography (HyCoSy), one blood test, and a semen analysis,would be sufficient as an initial screening test to selectcouples for specific treatment. Methods: The infertile couples underwent gynaecologicalexamination, cervical sampling for cytology and Chlamydiatrachomatis culture, B-mode transvaginal ultrasonographyand basic hormonal analyses followed by a HyCoSy, and asemen analysis. A preliminary diagnosis was made for allpatients. A management plan for treatment was suggestedwhen possible; otherwise further examinations wererecommended. The data were stored for later analysis and theroutine investigation protocol was then adhered to and afinal diagnosis and treatment were decided upon. Results: Agreement between the diagnosis based on HyCoSyand our routine protocol was present in 74% of cases(N = 73). In 13% (N = 13) there was partial agreement. In36% the HyCoSy based protocol was considered sufficientto suggest treatment. Conclusions: A simplified approach may lead to asignificant reduction in both the time and cost of investigating aninfertile couple.