26Jul 2018

TWO DAYS MINIMAL STIMULATION PROTOCOL WITH INTRAUTERINE INSEMINATION IN THE TREATMENT OF UNEXPLAINED INFERTILITY.

  • Prof Doctor, Assistant professor of obstetrics and gynecology, Benha university hospital, Qalubia district ? Egypt.
Crossref Cited-by Linking logo

  • Abstract
  • Keywords
  • References
  • Cite This Article as
  • Corresponding Author

Objective: To determine whether minimal stimulation with clomiphene and one injection of 150 IU of human menopausal gonadotrophin (hMG) provides pregnancy rates comparable with those in a conventional full hMG stimulation protocol for unexplained infertile patients undergoing intrauterine insemination (IUI). Methods: A prospective study was carried out at the Infertility Clinic of Elshorok hospital Benha Egypt. Two hundred couples with either unexplained infertility or ovulatory dysfunction cases who ovulated with clomiphene citrate (CC) but failed to conceive were offered ovarian stimulation with CC and hMG along with IUI for 200 cycles. Patients divided into two groups according to the stimulation protocol in group one patients given clomiphene citrate 50mg from day 3 to 7 two tablets per day with hMG (merional )75 unit injection on day 5 and 7 .in group two (full stimulation regimen clomiphene citrate given with hMG injection from day 5 to 9 daily then dose adjusted according to finding on trans-vaginal ultrasound scan of follicles . Pregnancy rate, medication and monitoring cost were compared between minimal and conventional stimulation protocols. Results: Number of ampoules of hMG and monitoring costs were significantly higher in the full hMG stimulation cases whereas pregnancy rate was comparable in both protocols. Conclusion: Minimal stimulation appears to be an effective protocol in cases of unexplained infertility undergoing intrauterine insemination.

  1. Sagnella F, Moro F, Lanzone A, Tropea A, Martinez D, Capalbo A, et al. A prospective randomized noninferiority study comparing recombinant FSH and highly purified menotropin in intrauterine insemination cycles in couples with unexplained infertility and/or mild-moderate male factor.?Fertil Steril.?2011;95:689?694.
  2. Wolff EF, Vahidi N, Alford C, Richter K, Widra E. Influences on endometrial development during intrauterine insemination: clinical experience of 2,929 patients with unexplained infertility.?Fertil Steril.?2013;100:194?199.
  3. Reindollar RH, Goldman MB. Gonadotropin therapy: a 20th century relic.?Fertil Steril.?2012;97:813?818.
  4. Azargoon A, Bahrami M, Alavy Toussy J. Comparing clomiphen citrate plus HMG with clomiphen citrate plus rFSH in IUI cycles in couples with unexplained or male factor infertility: A prospective randomized study.?Iran J Reprod Med.?2013;11(3):243?248.
  5. Merviel P, Heraud MH, Grenier N, Lourdel E, Sanguinet P, Copin H. Predictive factors for pregnancy after intrauterine insemination (IUI): an analysis of 1038 cycles and a review of the literature.?Fertil Steril.?2010;93:79?88.
  6. Corfman RS, Ory SJ, Milad MP, Erickson LD, Bellevance TL, Ball GD. A novel ovarian stimulation protocol for use with assisted reproductive technologies. Fertil Steril 1993; 60: 864?870.
  7. Goverde AJ, McDonnell J, Vermeiden JPW, Schats R, Rutten FFH, Schoemaker J. Intrauterine insemination or in-vitro fertilisation in idiopatic subfertility and male subfertility: a randomised trial and cost effectiveness analysis.?Lancet.?2000;355:13?18.
  8. Wolff EF, Vahidi N, Alford C, Richter K, Widra E. Influences on endometrial development during intrauterine insemination: clinical experience of 2,929 patients with unexplained infertility.?Fertil Steril.?2013;100:194?199.
  9. Coulam CB1374?1381., Moore SB, O'Fallon W. Investigating unexplained infertility. Am J Obstet Gynecol 1988; 158.
  10. Hughes E, Collins J, Vandekerckhove P. Clomiphene citrate for unexplained subfertility in Women.?Cochrane database Syst Rev.?2010;(1):CD000057. 31, 1588?1609.
  11. Gatimel N, Moreau J, Parinaud J & Leandri RD. (2017a) Sperm morphology: assessment, pathophysiology, clinical relevance, and state of the art in 2017. Andrology 5, 845?862.
  12. Gatimel N, Mansoux L, Moreau J, Parinaud J & Leandri RD. (2017b) Continued existence of significant disparities in the technical practices of sperm morphology assessment and the clinical implications: results of a French questionnaire. Fertil Steril 107, 365?372. e363
  13. Guzick DS, Carson SA, Coutifaris C, Overstreet JW, Factor-Litvak P, Steinkampf MP, Hill JA, Mastroianni L, Buster JE, Nakajima ST, Vogel DL & Canfield RE. (1999) Efficacy of superovulation and intrauterine insemination in the treatment of infertility. National Cooperative Reproductive Medicine Network. N Engl J Med 340, 177?183.
  14. Guzick DS, Overstreet JW, Factor-Litvak P, Brazil CK, Nakajima ST, Coutifaris C, Carson SA, Cisneros P, Steinkampf MP, Hill JA, Xu D, Vogel DL & National Cooperative Reproductive Medicine N. (2001) Sperm morphology, motility, and concentration in fertile and infertile men. N Engl J Med 345, 1388?1393.
  15. Haagen EC, Nelen WL, Grol RP, Braat DD, Hermens RP & Kremer JA. (2010) Variation in guideline adherence in intrauterine insemination care. Reprod Biomed Online 20, 533?542.
  16. Guideline adherence is worth the effort: a cost-effectiveness analysis in intrauterine insemination care (2013). Hum Reprod 28, 357?366.
  17. Helmerhorst FM, Oei SG, Bloemenkamp KW & Keirse MJ. (1995) Consistency and variation in fertility investigations in Europe. Hum Reprod 10, 2027?2030.
  18. Hunault CC, Habbema JD, Eijkemans MJ, Collins JA, Evers JL & te Velde ER. (2004) Two new prediction rules for spontaneous pregnancy leading to live birth among subfertile couples, based on the synthesis of three previous models. Hum Reprod 19, 2019?2026.
  19. Jedrzejczak P, Taszarek-Hauke G, Hauke J, Pawelczyk L & Duleba AJ. (2008) Prediction of spontaneous conception based on semen parameters. Int J Androl 31, 499?507.
  20. Keel BA, Stembridge TW, Pineda G & Serafy NT. (2002) Lack of standardization in performance of the semen analysis among laboratories in the United States. Fertil Steril 78, 603?608.
  21. Lemmens L, Kos S, Beijer C, Brinkman JW, van der Horst FA, van den Hoven L, Kieslinger DC, van Trooyen-van Vrouwerff NJ, Wolthuis A, Hendriks JC, Wetzels AM & Semen Section of the Dutch Foundation for Quality Assessment in Medical L (2016) Predictive value of sperm morphology and progressively motile sperm count for pregnancy outcomes in intrauterine insemination.Fertil Steril 105, 1462?1468.
  22. Lemmens L, Kos S, Beijer C, Braat DDM, Nelen W, Wetzels AMM & Dutch Foundation for Quality Assessment in Medical L. (2017) Techniques used for IUI: is it time for a change? Hum Reprod 32, 1835?1845.

[Mostafa Abdulla Elsayed Mahmoud. (2018); TWO DAYS MINIMAL STIMULATION PROTOCOL WITH INTRAUTERINE INSEMINATION IN THE TREATMENT OF UNEXPLAINED INFERTILITY. Int. J. of Adv. Res. 6 (Jul). 888-893] (ISSN 2320-5407). www.journalijar.com

mostafaabdulla7@gmail.com
professor

DOI:

Article DOI: 10.21474/IJAR01/7438      
DOI URL: https://dx.doi.org/10.21474/IJAR01/7438

Download Full Paper

Download PDF No. of Downloads: 13 | No. of Views: 120