Failure of hysteroscopic insemination of the fallopian tube in synchronized cycles.
The study consisted of a randomized, controlled trial of synchronized hysteroscopic insemination of the fallopian tube (SHIFT), in which selected infertile couples underwent hormonal delay of menstruation, ovulation induction, and insemination of a selected motile sperm population into the tubal isthmus above the utero-tubal junction. Of 40 couples recruited, only 2 became pregnant, both during a nonsynchronized control cycle. No conceptions were reported in either the 72 SHIFT or 73 non-SHIFT synchronized cycles. Hysteroscopic insemination was found to be a relatively easy procedure with a low rate of technical failure. There was low morbidity with no major clinical complications. However, 57% of tracked synchronized cycles showed a failed response to the follicular stimulation protocol; and 91% showed failure of follicular rupture greater than or equal to 52 hours after hCG induction. These failures of the ovulation synchronization/induction regimen were probably due to the use of medroxyprogesterone acetate for cycle synchronization, and should not preclude further evaluation of the technique of hysteroscopic insemination.