Stimulated IUI is much more effective than natural

Stimulated IUI is much more effective than natural hif pathway or controlled ovarian hyperstimulation treatment. In four randomized trials of patients with unexplained subfertility, pregnancy rates were higher when IUI was performed in stimulated cycles than in natural cycles [odds ratio (OR): 2.14; 95% confidence interval (CI): 1.26–3.61; pregnancy rates: 25% vs. 14% for stimulated and natural cycles, respectively, where 26 patients received clomiphene citrate, and 370 patients received gonadotropins]. According to the 2009 European Society of Human Reproduction and Embryology Capri Workshop, the pregnancy rates with clomiphene citrate and IUI were 7%, and with follicle stimulating hormone (FSH) ovarian stimulation and IUI they were 12% per cycle. However, there are various criteria affecting the success rate of IUI including age, indications of IUI, the optimal procedures for sperm preparation, insemination methods, and timing. There is not a consensus on the optimal timing of IUI. In the large majority of published studies, insemination is performed 32–36 hours following human chorionic gonadotropin (hCG) administration. A 2014 systematic review compared the optimum time interval from hCG injection to IUI, comparing different time frames ranging from 24 hours to 48 hours, and found no difference in the pregnancy rate per couple. Luciano et al showed that ultrasound-confirmed follicle rupture occurred on Day +1 of the luteinizing hormone (LH) surge in 6% of patients, on Day +2 in 72%, and on Day +3 in 21%. In light of this finding, it seems probable that IUI on Day +1 after hCG injection, plus properly timed intercourse, could achieve results similar to those obtained with IUI on Day +2 after hCG injection in infertile couples with normal spermiograms. The clinical effect of IUI on pregnancy rates for different infertility etiologies such as polycystic ovary syndrome (PCOS) and unexplained infertility has not yet been extensively evaluated. Although the efficiency of IUI procedures for unexplained infertility in patients has been proven, the clinical benefit of this procedure is not clear for PCOS patients whose central problem is anovulation rather than fertilization. The primary aim of this study was to elucidate the effect on clinical pregnancy rates of the IUI procedure performed at 24 hours or 36 hours after ovulation triggered by hCG, following ovulation induction with gonadotropins. The secondary aim of the study was to compare the clinical pregnancy rates for PCOS and unexplained infertility that is associated with the timing of IUI procedures, during ovulation induced by gonadotropins.
Methods This retrospective study was approved by the ethics committee of the Zekai Tahir Burak Women\'s Health Research and Education Hospital, Ankara, Turkey. One hundred and thirteen women diagnosed with PCOS (as per Rotterdam\'s criteria) or unexplained infertility were recruited from the medical records of the infertility clinic. Couples were evaluated with semen analyses, hysterosalpingogram and/or laparoscopy, and transvaginal sonographic screening performed in the early follicular phase of cycle and midluteal serum progesterone. The husbands of all patients had normal spermiogram results based on at least two semen analyses according to the World Health Organization 2010 criteria. All women had at least one tubal patency, documented by hysterosalpingogram and in some cases also by laparoscopy. Early follicular phase hormone assay (basal FSH, LH, estradiol (E2), prolactine (PRL), and thyroid stimulating hormone (TSH)) measurements were made on Day 3 of the cycle. Couples with endometriosis, uterine or tubal factor, poor ovarian reserve, and male infertility were excluded. Patients were classified into two groups according to their infertility diagnosis: unexplained (n = 78) and PCOS (n = 35). A couple was considered to have unexplained infertility when the results of semen analysis, hormonal assay, hysterosalpingography, and/or laparoscopy were normal.