Intrauterine insemination: A cross-sectional study on determinants of success / Philippine Journal of Obstetrics and Gynecology

Intrauterine insemination (IUI) together with controlled ovarian hyperstimulation (COH) has been increasingly used for the treatment of variety of subfertile indications, both male and female or even combined. The overall success rate of IUI ranges from 4% to 66%. The wide variance of success of the procedure is likely to be influenced by a number of factors. The pregnancy rate in the local setting has never been determined. This cross-sectional study reviewed all available clinical records of patients undergoing fertility work-up who had sperm processing in a hospital-based andrology unit and who underwent intrauterine insemination in either the hospital-based facility or a private clinic from January to December, 2004. Objective: It aimed to determine the pregnancy rate following IUI and assess the intrinsic and extrinsic variables affecting its success and describe the IUI's pregnancy outcome. The intrinsic factors include patient's age (male and female), number of subfertility years, previous reproductive history specifically involving the different factors (male, cervical, uterine, ovarian, tubal, peritoneal). Extrinsic factors include treatment effect and timing of IUI (medicine administered, monitoring of number and size of follicles, endometrial thickness, total motile count inseminated, number of inseminations) and preference for facility (hospital-based clinic or private clinics). Results: For the period of one year, there were a total of 1051 cycles of IUI, 305 in the hospital-based facility and 746 in private clinics. Due to limitation of accessible data, only 424 cycles were studied. However, out of the 424 cycles data retrieved, only 365 showed IUI outcomes. The overall pregnancy rate following IUI was 2.47%. In this study, it seems that only the wives' age (younger) and years of subfertility (2.9 years), were found to be associated with pregnancy rates. The median female age was 35.4 years (range 23.4-48.2), and median male age was 36.5 years (range: 25.0 - 54.4) with a median duration of subfertility of 6.0 years (range: 0.3 -18.0). Conclusion: There is no sufficient evidence to conclude that the other factors studied under treatment, different parameters and topography are associated with rates of pregnancy following IUI.

Comparison of three protocols for Controlled Ovarian Hyperstimulation (COH) for clomiphene citrate poor responders

Objective: To compare the efficacy of Letrozole and Gonadotropin, given alone or in combination, in controlled ovarian hyperstimulation in Clomiphene citrate poor responders. Study Design: Prospective, non-randomized observational study on Clomiphene citrate poor responders at the St. Luke's Medical Center setting from January to July 2006. Results: Letrozole and gonadotropins, whether given alone or in combination, have similar clinical outcomes in terms of endometrial thickness during ovulation and the number of dominant follicles developed. The use of gonadotropins results in 100% ovulation rate, similar to results when Letrozole is used as an adjunct. Letrozole significantly reduces the dose of gonadotropin required to develop a mature follicle. Conclusion: Since the use of Letrozole and gonadotropins for ovarian hyperstimulation had similar results, Letrozole has the advantage of reduced cost and greater patient acceptance. It may be used alone or in conjunction with gonadotropins for poor responders to Clomiphene citrate.