Which is the best intrauterine insemination timing choice following exogenous hCG administration during ovulation induction by using clomiphene citrate treatment? A retrospective study

The treatment of unexplained infertility has traditionally been comprised of a stepwise treatment approach, first with ovulation induction combined with intrauterine insemination (IUI) and then with in vitro fertilization (IVF). Ovulation induction is first attempted with clomiphene citrate, and, if unsuccessful, injectable gonadotropins are used. The value of ovulation induction with injectable gonadotropins in couples with unexplained infertility has been questioned, however, given the high risk of multiple gestation and the increasing efficacy of IVF. To address this, the FASTT trial randomized couples with unexplained infertility to a treatment arm that either included or omitted gonadotropin/IUI. They found that an accelerated treatment approach that involved 3 cycles of clomiphene citrate/IUI and then progressed immediately to IVF resulted in a decreased time to pregnancy compared to the group who underwent gonadotropin/IUI for 3 cycles, as well as decreased cost per live birth. Therefore, it was concluded that treatment of couples with unexplained infertility with gonadotropin/IUI was of no additional benefit.

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A study for evaluation of two protocols comprising of clomiphene citrate, human menopausal gonadotropin with or without follicle stimulating hormone for ovulation induction in patients with infertility for intrauterine insemination

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20192455 ◽

2019 ◽

Vol 8 (6) ◽

pp. 2487

Author(s):

Ashok Verma ◽

Shivani Sharma ◽

Suresh Verma ◽

Pankaj Sharma ◽

Tenzin Tsamo Tenga ◽

...

Keyword(s):

Menstrual Cycle ◽

Pregnancy Rate ◽

Ovulation Induction ◽

Endometrial Thickness ◽

Intrauterine Insemination ◽

Clomiphene Citrate ◽

Human Menopausal Gonadotropin ◽

Multiple Gestation ◽

Group A ◽

Group B

Background: To compare two protocols comprising of FSH/CC/HMG and CC/HMG for ovulation induction and IUI in women with infertility.Methods: 60 women with unexplained infertility were randomized using sequentially numbered opaque envelope method. Group A received inj FSH 150 units on day 2 of menstrual cycle and clomiphene citrate 100 mg from day 3-7, followed by injection HMG 150 units on day 9 of menstrual cycle. Group B received clomiphene citrate 100 mg from day 3-7, and HMG 150 units on day 7 and 9 of the menstrual cycle. Ovulation triggered with hCG 5000 units when dominant follicle was 18mm. Single IUI was done 36-42 hours afterwards.Results: Pregnancy occurred in 3 out of 30 women in 116 cycles Group A (with FSH) with a pregnancy rate of 10 percent, and 2.8% per cycle. In group B (without FSH) pregnancy occurred in 3 out of 30 women in 117 cycles with pregnancy rate of 10 percent, and 2.6% per cycle. The number of follicles per cycle was 1.36 and follicle size was 18.57 mm in group A. While in Group B numbers of follicles per cycle were 1.22, with average size of 18.9mm. Mean endometrial thickness was 7.7mm in Group A and 6.37 in Group B (p=.01, significant). Mild OHSS was observed in one woman in Group B. No other side effects were observed in both the groups.Conclusions: The controlled ovarian stimulation regimes used in this study are equally effective, easy to administer, require less intensive monitoring and fewer medications, with little risk of OHSS and multiple gestation.

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Pregnancy rates from intrauterine insemination are equivalent following 1- versus 5-day letrozole administration for ovulation induction: a retrospective study

F&S Reports ◽

10.1016/j.xfre.2020.07.003 ◽

2020 ◽

Vol 1 (3) ◽

pp. 202-205

Author(s):

Kaitlin McGrail ◽

Susan Conway ◽

John Storment ◽

Sarah Buzhardt ◽

Neil Chappell

Keyword(s):

Retrospective Study ◽

Ovulation Induction ◽

Intrauterine Insemination ◽

Pregnancy Rates

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The Study on Different Ovulation Induction Protocols used for Intrauterine Insemination and their Pregnancy Rate in Infertile Couples

International Journal of Current Microbiology and Applied Sciences ◽

10.20546/ijcmas.2021.1011.010 ◽

2021 ◽

Vol 10 (11) ◽

pp. 73-82

Author(s):

Yaminipriya Devarajlu Dhivya Venkatesan ◽

Balachandar Vellingiri Ravimanickam Thangarasu ◽

Sarat Battina

Keyword(s):

Pregnancy Rate ◽

Ovulation Induction ◽

Intrauterine Insemination ◽

Clomiphene Citrate ◽

Human Menopausal Gonadotropin ◽

Fertility Drugs ◽

Group I ◽

Significant Difference ◽

Group B ◽

Group D

Infertility affects millions of people of reproductive age worldwide and has an impact on their families and communities. Infertility is a disease of male or female reproductive system defined by failure to achieve a pregnancy after 12 months or more of regular unprotected sexual intercourse. Infertility is treated by different fertility drugs, ovulation induction (OI), intrauterine insemination (IUI) and in-vitro fertilization (IVF). The aim of the study is to find out the significant difference in pregnancy rate with different OI protocols used for IUI. OI is the first line treatment given to infertile women. In OI, medications are given to women for egg development and for release of eggs. OI is monitored by follicular study by ultrasonography. Semen is collected from the male partner and processed with culture media to retrieve high motile sperms, which are injected into the uterus of the female. A prospective randomized study was performed among 1343 IUI cycles. OI is started on Day 2 or Day 3 of the menstrual cycle. OI protocol is grouped according to the fertility drugs used for stimulation. The fertility drugs used for the stimulation are Clomiphene Citrate, Letrozole, Recombinant Gonadotropins, Human menopausal Gonadotropins (HMG), Human chorionic Gonadotropin (HCG). Group A uses Clomiphene citrate and HCG, Group B uses Clome, recombinant Gonadotropins and HCG. Group C uses Clome, Human menopausal Gonadotropin and HCG; Group D uses Letrozole and HCG. Group E uses Letrozole recombinant Gonadotropin and HCG. Group F used Letrozole, Human menopausal Gonadotropin and HCG. Group G used recombinant Gonadotropin and HCG. Group H used Human menopausal Gonadotropin and HCG. Group I uses only HCG. Group J was a natural cycle monitoring without any medication and was used as a control. Pregnancy rates were calculated for different age groups with different protocols. The result shows that Group B had 13% pregnancy, Group C had 9%, Group D had 3%, Group E had 10%, Group G had 11%, Group G had 11%, Group H had 7%, Group I had 4%, and Group J had 8% of pregnancy rate. The statistical analysis shows there is no significant difference with different stimulation protocols used.

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Comparison of the efficiency of clomiphene citrate and letrozole in combination with metformin in moderately obese clomiphene citrate - resistant polycystic ovarian syndrome patients

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh1604146b ◽

2016 ◽

Vol 144 (3-4) ◽

pp. 146-150 ◽

Cited By ~ 3

Author(s):

Artur Bjelica ◽

Aleksandra Trninic-Pjevic ◽

Ljiljana Mladenovic-Segedi ◽

Nenad Cetkovic ◽

Djordje Petrovic

Keyword(s):

Retrospective Study ◽

Polycystic Ovary Syndrome ◽

Pregnancy Rate ◽

Polycystic Ovary ◽

Intrauterine Insemination ◽

Clomiphene Citrate ◽

Obese Patients ◽

Ovary Syndrome ◽

Metformin Therapy ◽

Significant Difference

Introduction. Polycystic ovary syndrome is the most common endocrinopathy in women of reproductiveage. Therapy for those who want to get pregnant involves ovulation induction using clomiphene citrate, metformin, letrozole and gonadotropins. Objective. The aim of the study was to compare the efficacy of combinations of clomiphene citrate-metformin and letrozole-metformin in obese patients who are resistant to clomiphene citrate alone. Methods. The investigation was conducted as a retrospective study involving 60 moderately obese patients with polycystic ovary syndrome. Thirty-one of them received the clomiphene citrate-metformin, and 29 letrozole-metformin therapy. Stimulation was carried out for the procedures of intrauterine insemination (IUI). Results. The age of patients, duration of infertility, and body mass index in both groups were similar. There was statistically significant difference in the thickness of the endometrium in favor of the group having the letrozole-metformin therapy (8.9 ? 1.7 mm) compared with the group receiving the clomiphene citrate-metformin treatment (6.3 ? 1.3 mm). The number of follicles was not statistically significantly different. Pregnancy rate in the first cycle of IUI in the clomiphene citrate group was 6.4%, and 17.2% in the letrozole group, which also was not statistically different. After the third IUI cycle, the pregnancy rate was significantly higher in the letrozole group (20.6%), while in the clomiphene citrate group it was (9.6%). Conclusion. This retrospective study demonstrated the advantages of the use of letrozole over clomiphene citrate in combination with metformin in moderately obese patients with polycystic ovary syndrome who are resistant to stimulation with clomiphene citrate alone.

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