Intrauterine insemination with avarian hperstimulation for treatment of comples with unexplained infertility

ABSTRACT

Treatment of couples with unexplained infertility includes many therapeutic modalities that range from expectant management to the most sophisticated assisted reproductive techniques [ARTs] as IVF and GIFT. As such, we evaluated the clinical efficacy of ovarian hyperstimulation with intrauterine insemination [IUI] as an easy and economic method of ARTs for treatment of couples with unexplained infertility. A total of 112 couples with unexplained infertility, despite of the normal finding of the infertility diagnostic work-up, were selected for this study. The male partner was evaluated by history taking, physical examination, scrotal doppler examination for varicocele, 3 consecutive semen analysis, and hormonal profile that included FSH, LH, prolactin and testosterone. The protocol of female evaluation included history taking, clinical examination, postcoital test, hormonal assay for serum prolactin, luteal phase of serum progesterone and thyroid function test, ultrasound pelvic examination with ovarian folliculometry, hysterosalpingography, premenstrual endometrial biopsy laparoscopy and hysteroscopy. All selected couples were managed by controlled ovarian hyperstimulation in combination with IUI for up to 3 cycles. Vaginal ultrasound scan was used for monitoring of the treatment cycles. A total of 171 treatment cycles were made and 27 clinical pregnancies were achieved [25 term and ongoing pregnancies and 2 spontaneous abortions]. The total pregnancy rate was 24.1% per patient and 15.8% per treatment cycle. The successful pregnancy rate was 22.3% and 14.6% per patient and per treatment cycle respectively. Controlled ovarian hyperstimulation in combination with IUI achieved a reasonable success rate in the treatment of couples with unexplained infertility and should be offered before considering the more sophisticated and expensive assisted reproductive techniques