ABSTRACT
Background: The high prevalence of infertility has made it a major healthcare problem in the present era. A majority of patients presenting with infertility have poor ovarian reserve (POR). Patients with POR are challenging to treat due to reduced treatment success and high cycle cancellation rate as there is no uniform definition and treatment protocol for these patients. The present retrospective study was performed to compare the pregnancy outcome between a long agonist protocol and flexible antagonist protocol in patients with POR. Patients with AMH ≤1.5 ng/mL and AFC ≤4 was included in the study. Controlled ovarian hyperstimulation is the basis of any in vitro fertilisation (IVF) procedure. There is no universally accepted ideal stimulation protocol for patients with POR, and it remains a challenge.Methods: This was a retrospective study covering the period from May 2019 to March 2020. Ninety-nine patients with low ovarian reserve (AMH ≤1.5 ng/mL and AFC ≤4) were included in the study. The patients underwent GnRH agonist/GnRH antagonist stimulation protocol using recombinant FSH. Demographic characteristics like age, BMI, duration of infertility was comparable. Total days of stimulation, total Gonadotropin dose used and clinical pregnancy rate in both the protocols was analyzed. Difference between the two groups was considered statistically significant at p-value <0.05.Results: Fifty-three patients underwent antagonist stimulation protocol and forty-six long agonist protocol. The clinical pregnancy rate was 37.7% (20/53) and 32.6% (15/46) in antagonist and agonist protocol respectively (p-value=0.5983). Pregnancy rate was higher in the antagonist group but the difference was not statistically significant.Conclusions: Antagonist protocol could marginally increase pregnancy rate in patients with low ovarian reserve. However, patients with poor ovarian reserve require a tailor-made protocol.
ABSTRACT
Background: Intrauterine insemination (IUI) remains an inexpensive, non-invasive, and effective first-line artificial insemination technique. The technique of IUI has evolved through various innovations since the time Cohen published the first report of IUI in 1962, and the success rate increased from 5% to >20%. The success of IUI depends upon several factors; two such prognostic factors are the timing and frequency of insemination. The objective of this study was to compare the effectiveness of single versus double intrauterine insemination.Methods: This prospective randomized study was carried out in 130 patients with male factor infertility, PCOS and unexplained infertility. Patients were randomly assigned into two groups. In the first group of 65 patients, single IUI was applied at 36 to 40 hours after HCG administration, to the other 65 patients in the second group, double IUIs were applied at 12 to 16 hours and 36 to 40 hours after HCG administration. The primary end-point of the study was to compare the clinical pregnancy rate between the two groups.Results: The overall pregnancy rate was 18.46% (12/65) for single IUI group and 30.76% (20/65) for double IUI group. There was a no statistically significant difference between single and double IUI groups (p=0.16).Conclusions: This study did find a higher pregnancy rate following double IUI; however, the difference was not statistically significant. Further, larger sample size studies are required to determine if double IUI increases the pregnancy rate.