Ovulation before or after intrauterine insemination does not affect live birth rates: a retrospective cohort study of 6701 cycles

Effect of ovulation before or after intrauterine insemination on pregnancy outcome in patients with unexplained infertility or polycystic ovarian syndrome

OBJECTIVE

To investigate the relationship between ovulation and pregnancy outcomes in patients undergoing intrauterine insemination (IUI).

METHODS

The clinical data from 784 patients, diagnosed with polycystic ovarian syndrome (PCOS) or unexplained infertility, underwent 1624 IUI cycles were analyzed retrospectively. Ovulation was observed by transvaginal ultrasonography on the day of IUI. The clinical pregnancy rate (CPR), abortion rate (AR), and live birth rate (LBR) were analyzed.

RESULTS

The study included 1031 pre-ovulation IUI cycles (63.49%) and 593 post-ovulation IUI cycles (36.51%). The CPR was 13.05%, the AR was 15.57%, and the LBR was 11.02%. Ovulation before or after IUI affected the CPR (11.06% VS 16.53%, p = .002) and LBR (9.41% VS 13.83%, p = .006) per cycle, but did not affect the AR (14.91% VS 16.33%, p = .149). The sex ratio of children was not related to ovulation (p = .948). After adjusting for baseline characteristics and logistic regression, the CPR (OR = 1.931, 95% CI 1.062-1.931, p = .019) and LBR (OR = 1.389, 95% CI 1.007-1.916, p = .045) of post-ovulation insemination were higher than those of pre-ovulation insemination significantly.

CONCLUSION

Pregnancy outcomes were affected by ovulation on the day of IUI in patients with unexplained infertility or PCOS. Post-ovulation insemination may improve the CPR of IUI.

DUAL TRIGGER STRATEGY AFTER CONTROLLED STIMULATION INTRAUTERINE INSEMINATION CYCLE DID NOT INFLUENCE THE PREGNANCY OUTCOME COMPARED WITH STANDARD HCG TRIGGER ONLY PROTOCOL

OBJECTIVE

The aim: A prospective randomized comparative study was conducted to investigate the effect of dual trigger, using gonadotropin releasing hormone agonist with human chorionic gonadotropin (hCG) versus hCG alone, for ovulation trigger in controlled ovarian stimulation intrauterine insemination (IUI) cycle on pregnancy outcome.

PATIENTS AND METHODS

Materials and methods: Ninety women were randomly allocated into equal groups to trigger ovulation for IUI cycle using either method; IUI was performed following 36-42 hours post triggering. Luteinizing hormone (LH) and progesterone levels were measured at insemination day.

RESULTS

Results: The baseline of demographic and clinical characteristics of both groups was similar. Progesterone level was higher in dual trigger group than in hCG alone group (1.61 versus 0.71 ng/mL, P≤0.0001); while LH level was lower in dual trigger group (19.35 versus 24.51 IU/L, P≤0.014). Furthermore, LH level at the day of IUI was higher in pregnant women than in non-pregnant (27.9 versus 20 IU/L, P≤0.007).

CONCLUSION

Conclusions: Pregnancy rate was equivalent in both groups. More intensive investigation is required to study the efficacy of the dual trigger in IUI cycle.