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PubMed2005

Fertility response of yearling beef heifers after prebreeding energy manipulation, estrous synchronization and timed artificial insemination.

The effect of dietary energy and weight class on the fertility of yearling beef heifers (Angus, Hereford, and Angus x Hereford) was investigated over 2 years. In year 1, heifers (n=58) were classed as heavy (HW; > or =340 kg) or light weight (LW; <340kg) and then assigned to receive either a low (LE; 0.23 kg/day) or high energy (HE; 0.68 kg/day) diet. In year 2, heifers (n=60) were also classified as heavy (> or =335kg) or light weight (<335 kg), but the energy content of the diet was raised so that heifers on the LE and HE were targeted to gain 0.46 and 0.79 kg/day, respectively. Heifers in the four groups, LELW (n=14 and 12), LEHW (n=16 and 17), HELW (n=13 and 15), and HEHW (n=15 and 16) received restricted amounts of concentrate (HE > LE) and free choice hay over 47 or 42 days (year 1 and year 2, respectively). To synchronize estrus, heifers were fed capsules containing MGA (0.5 mg/animal each day) beginning 11 days before the end of the feeding trial (day 0), PGF(2alpha) (25mg i.m.) and estradiol benzoate (Ebeta; 400 microg i.m.) was given on days 8 and 10, respectively. Estrous behavior was observed (days 10 and 11) and all heifers were inseminated on day 11. Following AI, heifers were re-grouped and a bull was introduced (days 27-39) for the second service in both years. Pregnancy diagnosis for the first (days 41-42) and second services (days 69-97) was performed by transrectal ultrasonography. Transrectal ultrasonic observations of ovarian follicle number and size were completed for a subset of heifers (n=5-8) from each experimental group at the end of the feeding trial. The effect of year was not significant for any of the reproductive performance variables measured. The mean ADG was (0.72 +/- 0.04 kg/day) and was greater in LW than HW heifers and in heifers in the HE than LE treatment groups (P <0.05). In heifers receiving the LE diet, ADG was lower in HW than LW heifers (weight x diet; P=0.02; 0.54 +/- 0.04 and 0.62 +/- 0.03 kg/day for HW and LW heifers, respectively). The diameter of the largest follicle was greater in heifers receiving the HE diet (P < 0.05; 11.3 +/- 0.4 mm) than those on the LE diet (10.3 +/- 0.3), and in LW (P <0.05) compared to HW heifers. The HE diet increased the size of the largest follicle in LW but not HW heifers (diet x weight, P <0.05). The percentage of pubertal heifers at the end of the feeding period (59.3%), estrous response (56.4%), conception rate (47.7%), ovulation rate (88.9%), and first service pregnancy rate (36.2%) were not significantly affected by initial weight or diet. There was a tendency for first service pregnancy rates to be greater in LW than HW heifers consuming the LE diet (diet x weight, P <0.1; 54.2 +/- 15 and 30.3 +/- 10% for LELW and LEHW heifers, respectively). Pregnancy rate after two services was greater (P=0.01) in LW (82 +/- 10%) than in HW (64.5 +/- 10%). The LE diet achieved moderate rates of gain and allowed high level of reproductive performance in LW but not HW heifers.

Animals↗
PubMed2005

Conception rates and serum progesterone concentration in dairy cattle administered gonadotropin releasing hormone 5 days after artificial insemination.

The objectives of this study were to determine the effect of administration of exogenous GnRH 5days after artificial insemination (AI) on ovarian structures, serum progesterone concentration, and conception rates in lactating dairy cows. In experiment 1, 23 Holstein cows were synchronized using the Ovsynch protocol. Five days after AI (day 0) cows were assigned randomly to receive either saline (saline; n=11) or 100microg GnRH (GnRH; n=12). To examine ovarian structures, ultrasonography was performed on day 1 and every other day beginning on day 5 until day 13. On days 5 and 13 blood samples were obtained to measure serum progesterone concentrations. All cows in the GnRH-treated group developed an accessory corpus luteum (CL), whereas cows in the saline group did not. Mean serum progesterone concentrations did not differ between GnRH and saline groups on day 5 (1.64+/-0.46ng/ml versus 2.04+/-0.48ng/ml). On day 13 serum progesterone concentrations were greater (P<0.05) in the GnRH group compared with saline (5.22+/-0.46ng/ml versus 3.36+/-0.48ng/ml). In experiment 2, 542 lactating cows, at two different commercial dairies, were used to test the effect of administering GnRH 5 days after AI on conception rates. Cows were synchronized and detected for estrus according to tail chalk removal. Cows detected in estrus received AI within 1h after detection of estrus. Five days after AI, cows were assigned randomly to receive either GnRH (n=266) or saline (n=276). Pregnancy status was determined by palpation per rectum of uterine contents approximately 40 days after AI. There was no effect of farm on conception rate. There was no effect of treatment as conception rates did not differ between GnRH and saline groups (26.7% GnRH versus 24.3% saline). Regardless of treatment, days in milk, parity, milk yield, and number of services had no effect on the odds ratio of pregnancy. In summary, the results of this study indicated that GnRH administered 5 days after AI increased serum progesterone by developing an accessory CL but did not improve conception rates in dairy cattle.

Animals↗
PubMed2004

Use of frozen semen to avoid human immunodeficiency virus type 1 transmission by donor insemination: a cost-effectiveness analysis.

OBJECTIVE: Reappraisal of current guidelines mandating frozen-thawed semen. DESIGN: Cost-effectiveness analysis comparing the use of frozen semen with the use of fresh semen from the same donors without a second antibody test. SETTING: A Markov model computer simulation. PATIENT(S): A theoretical cohort of 80000 women whose husbands are azoospermic. INTERVENTION(S): Simulation with calculation of costs and payoffs. MAIN OUTCOME MEASURE(S): Total lifetime direct health care costs, costs per live birth, life expectancy, quality adjusted life years (QALY), marginal cost effectiveness (dollar/QALY). RESULT(S): If all 80000 women who undergo donor insemination in the United States each year chose to use fresh semen from donors screened according to the current practice guidelines but without semen cryopreservation, there would be 8881 more births and the mean cost per live birth would be US dollars 15501 less. One recipient would become infected with HIV-1 every 5.1 years, during which time over 180000 noninfected children would be born. The average life expectancy of recipients would be reduced by 2 days, but their quality-adjusted life expectancy would increase by over 1 month. Medicolegal costs to physicians would need to exceed US dollars 780 million per infection to equalize the cost effectiveness of the fresh and frozen policies. CONCLUSION(S): The guidelines should be revised to allow the use of fresh semen by informed recipients.

Adult↗
PubMed2004

Clomiphene citrate intrauterine insemination (IUI) before gonadotropin IUI affects the pregnancy rate and the rate of high-order multiple pregnancies.

OBJECTIVE: To determine if previous treatment with clomiphene citrate intrauterine insemination (CC-IUI) affects pregnancy and high-order multiple pregnancy (HOMP) rates in subsequent hMG-IUI or FSH-IUI cycles. DESIGN: Retrospective cohort study. SETTING: Private infertility clinic. PATIENT(S): Five hundred fifty-one patients (age <38 years) without tubal factor infertility, treated with 918 cycles of hMG/FSH-IUI after one or more unsuccessful cycles of CC-IUI; 908 patients treated with 1459 cycles of hMG/FSH-IUI without prior CC-IUI. INTERVENTION(S): CC-IUI, hMG-IUI, FSH-IUI. MAIN OUTCOME MEASURE(S): Pregnancy rate per cycle, HOMP (three or more gestational sacs). RESULT(S): Pregnancy rates during the first three hMG-IUI or FSH-IUI cycles averaged 21.8 +/- 1.1% without previous CC-IUI, 19.6 +/- 1.3% after one to four cycles of CC-IUI, and 3.6 +/- 2.6% after >or= five previous CC-IUI cycles. The HOMP rates were 8.8% without previous CC-IUI, 7.5% after one, 5.7% after two and <2.6% (0 out of 38) after >or= three previous CC-IUI cycles. CONCLUSION(S): Pregnancy rates in hMG/FSH-IUI cycles are significantly reduced after four unsuccessful CC-IUI cycles. High-order multiple pregnancies due to hMG/HMG-IUI are reduced following previous unsuccessful CC-IUI cycles.

Adult↗
PubMed2004

Prediction of an ongoing pregnancy after intrauterine insemination.

OBJECTIVE: To develop a prognostic model for the outcome of IUI. DESIGN: Retrospective cohort study. SETTING: Four fertility centers in The Netherlands. PATIENT(S): Couples of whom the female partners had a regular cycle and who had been treated with IUI. INTERVENTION(S): Intrauterine insemination with and without ovarian hyperstimulation. MAIN OUTCOME MEASURE(S): Ongoing pregnancy. RESULT(S): Overall, 3371 couples were included who underwent 14968 cycles. There were 1229 (8.2%) pregnancies, of which 1000 (6.7%) pregnancies were ongoing. Logistic regression analysis demonstrated that increasing maternal age, longer duration of subfertility, presence of male factor subfertility, one-sided tubal pathology, endometriosis, uterine anomalies, and an increasing number of cycles were unfavorable predictors for an ongoing pregnancy. Cervical factor and the use of ovarian hyperstimulation were favorable predictors. The area under the receiver operating characteristic curve was 0.59. When couples were divided into four categories based on prognosis, the difference between the predicted and observed chance, that is, the calibration, was less than 0.5% in each of the four groups. CONCLUSION(S): Although our model had a relatively poor discriminative capacity, data on calibration showed that the selected prognostic factors allow distinction between couples with a poor prognosis and couples with a good prognosis. After external validation, this model could be of use in patient counseling and clinical decision making.

Adult↗
PubMed2004

For now, one well-timed intrauterine insemination is the way to go.

Two articles on pregnancy rates from superovulation and IUI in relation to the IUI protocol were reviewed. Results from a meta-analysis of IUI number (one vs. two) and from a randomized trial of IUI timing (33 hours vs. 39 hours after hCG administration) suggest that one well-timed insemination within several hours of ovulation represents a reasonable balance between efficacy and cost.

Female↗
PubMed2004

Insemination with isolated and virologically tested spermatozoa is a safe way for human immunodeficiency type 1 virus-serodiscordant couples with an infected male partner to have a child.

OBJECTIVE: To enable serodiscordant couples to reproduce while minimizing the risk of infecting the female partner and to demonstrate the feasibility of including these couples in an insemination program. DESIGN: Prospective follow-up study. SETTING: Ambulatory IUIs. PATIENT(S): Fifty-six HIV-1-serodiscordant couples with a male infected partner. INTERVENTION(S): Sperm cell separation by the gradient density method followed by the swim-up method, virological detection, and IUI after ovarian stimulation. MAIN OUTCOME MEASURE(S): Pregnancy rate, HIV-1 test, and p24 antigenemia in women. RESULT(S): Two hundred thirteen IUIs were performed, and 37 pregnancies occurred, resulting in 33 births and 2 ongoing pregnancies. Fifty percent of couples have a child. No women were infected. CONCLUSION(S): Our study demonstrates the efficiency of an IUI program with prepared and virologically tested spermatozoa in serodiscordant couples with an HIV-1-infected male partner, allowing the couples to have children without transmission of the virus to the female partner.

Adult↗
PubMed2004

Intrauterine insemination (IUI) pregnancy outcome is enhanced by shorter intervals from semen collection to sperm wash, from sperm wash to IUI time, and from semen collection to IUI time.

OBJECTIVE: To determine whether IUI pregnancy was affected by [1] place of semen collection (home vs. clinic), and [2] intervals from collection to sperm wash (C-SW), from sperm wash to IUI (SW-IUI), and from collection to IUI (C-IUI). DESIGN: Retrospective study. SETTING: Infertility clinic. PATIENT(S): Sixty-two couples in 132 cycles. INTERVENTION(S): Clomiphene citrate (CC) or hMG, plus hCG, and IUI. MAIN OUTCOME MEASURE(S): Ultrasonographic detection of fetal heart beat(s). RESULT(S): Semen collection at clinic resulted in a higher pregnancy rate than collection at home in hMG-treated (44% vs. 18%; P=.03) but not in CC-treated women (9% vs. 9%; P=.93). Intervals of C-SW, SW-IUI, and C-IUI were shorter in pregnant than in nonpregnant hMG-treated women (27 vs. 41 minutes, 42 vs. 85 minutes, and 99 vs. 156 minutes, respectively; P< or =.01) but not in CC-treated women (28 vs. 38 minutes, 51 vs. 63 minutes, and 109 vs. 131 minutes, respectively; P> or =.19). Semen processed within 30 minutes after collection resulted in a higher pregnancy rate than that processed 31-60 minutes after collection in hMG-treated (48% vs. 18%; P=.02) but not in CC-treated women (10% vs. 8%; P=.81). Intrauterine insemination performed within 90 minutes of collection resulted in a higher pregnancy rate than IUI performed at 91-120 minutes or >120 minutes after collection in hMG-treated (99% vs. 22% and 7%, respectively; P<.0001) but not in CC-treated women (11%, 4%, and 10%, respectively; P> or =.46). CONCLUSION(S): For i.u.i. with hMG but not CC, semen collection at the clinic is more effective than, and should be chosen over, collection at home. Delaying semen processing from 30 minutes up to 1 hour and/or delaying IUI from 90 minutes up to 2 hours after collection compromises the pregnancy outcome in hMG-IUI cycles. Semen specimens should be processed as soon as just after liquefaction and within 30 minutes of collection, and IUI performed as soon as just after processing and within 90 minutes of collection.

Adult↗
PubMed2006

Impact of leuprolide acetate on luteal phase function in women undergoing controlled ovarian hyperstimulation and intrauterine insemination.

OBJECTIVE: To determine if the combination of leuprolide acetate (LA) and human menopausal gonadotropin (hMG) results in luteal phase dysfunction. DESIGN: A prospective, randomized clinical trial. SETTING: A tertiary care university fertility center. PATIENT(S): One hundred thirty-five couples with various etiologies of infertility. INTERVENTION(S): Patients were prospectively randomized to receive either hMG and intrauterine insemination (IUI) or luteal phase down-regulation with LA, hMG, and IUI. MAIN OUTCOME MEASURE(S): Serum luteal phase progesterone (P) and luteal phase estradiol (E2) were obtained 9 days after hCG administration. Twenty-four-hour urinary P and luteinizing hormone (LH) were analyzed 9 days after human chorionic gonadotropin (hCG). Endometrial biopsies were performed 11 days after hCG and evaluated for luteal phase defects (LPD) using Noyes' criteria. RESULT(S): No significant differences in the incidence of LPD (11.9% vs. 13.9%), cycle fecundity (16.6% vs. 16.3%), or luteal phase hormone profiles were observed between the groups receiving and not receiving LA. A significant difference in E2 levels (on the day of hCG administration) between cycles with a luteal phase defect (967 pg/mL +/- 106) and without a luteal phase defect (1,422 pg/mL +/- 83) was observed (P<.05). CONCLUSION(S): Pituitary down-regulation with LA combined with hMG did not result in luteal phase dysfunction. The E2 levels on the day of hCG administration in both groups were lower in women with documented luteal phase defects.

Adult↗
PubMed2006

Use of gonadotropin-releasing hormone antagonists to overcome the drawbacks of intrauterine insemination on weekends.

OBJECTIVE: To assess the usefulness of the GnRH antagonist cetrorelix to prevent LH surge and to avoid intrauterine insemination at weekends when a gynecologist on duty is not available and the ultrasound scan on Friday showed > 1 and < 3 follicles > or = 17 mm in diameter. DESIGN: Open-label, randomized, prospective study. SETTING: Reproductive medicine unit in an acute care teaching hospital in Barcelona, Spain. PATIENT(S): Infertile patients undergoing controlled ovarian hyperstimulation (COH) and IUI. INTERVENTION(S): Treatment with recombinant FSH was started on day 3. In women assigned to the control group (n = 32), recombinant FSH was continued up to the day of hCG administration. In patients assigned to the GnRH antagonist group (n = 35), half of the dose of recombinant FSH was given for 2 more days in addition to cetrorelix (0.25 mg SC) until the day of hCG administration. MAIN OUTCOME MEASURE(S): Recombinant FSH doses, E(2) level on the day of hCG administration, number and diameter of follicles, endometrial thickness, and number of pregnancies. RESULT(S): Only a case of premature ovulation occurred in the cetrorelix group. There were no significant differences between the study groups in the total mean number of follicles, follicles > 10 mm and < 17 mm, and follicles > or = 17 mm. The mean concentration of E2 on the day of hCG administration and the endometrial thickness were significantly higher in the cetrorelix group. Eleven pregnancies were achieved, 7 (20%) in the cetrorelix group (4 singleton, 3 twins) and 4 (12.5%) in controls (4 singleton). No case of ovarian hyperstimulation syndrome (OHSS) occurred. CONCLUSION(S): The use of cetrorelix to avoid IUI at weekends when the ultrasound scan on Friday shows > 1 and < 3 follicles > or = 17 mm is a useful alternative for medical centers in which a gynecologist on call is not available.

Adult↗
PubMed2006

Predictive value of the hemizona assay for pregnancy outcome in patients undergoing controlled ovarian hyperstimulation with intrauterine insemination.

OBJECTIVE: The hemizona assay (HZA) is an established functional test that examines in vitro sperm-zona pellucida binding capacity with high predictive power for fertilization outcome in IVF. The objective of this study was to evaluate the value of the HZA as a predictor of pregnancy in patients undergoing controlled ovarian hyperstimulation (COH) and intrauterine insemination (IUI). DESIGN: Prospective clinical study. SETTING: Academic center. PATIENT(S): Eighty-two couples with unexplained or male factor infertility that underwent 313 IUI cycles. INTERVENTION(S): Basic semen analysis and HZA were performed within three months of starting COH/IUI therapy. MAIN OUTCOME MEASURE(S): Hemizona index (HZI) and clinical pregnancy. RESULT(S): Overall, patients with an HZI of <30 had a significantly lower pregnancy rate compared to patients with an HZI of > or =30 (11.1% vs. 40.6%, respectively; P<.05; relative risk for failure to conceive: 1.5 (confidence interval 1.2-1.9)). In all patients combined, and in the range of HZI 0-60, the duration of infertility (P=.000) and the HZI (P=.004) were significant determinants of conception (receiver operating characteristics (ROC) analysis). In couples with male infertility, the average path velocity and HZI were significant predictors of conception (P=.001 and P=.005, respectively, ROC analysis). The negative and positive predictive values of the HZA for pregnancy were 93% and 69%, respectively. Logistic regression analysis provided models of HZI (P=.021) and duration of infertility (P=.037) with highest predictability of conception in male factor and unexplained infertility groups, respectively. CONCLUSION(S): The HZA predicted pregnancy in the IUI setting with high sensitivity and negative predictive value in couples with male infertility. Results of this sperm function test are useful in counseling couples before allocating them into COH/IUI therapy.

Adult↗
PubMed2006

Association of obesity with treatment outcomes in ovulatory infertile women undergoing superovulation and intrauterine insemination.

OBJECTIVE: To evaluate the association between obesity and the outcome of superovulation and intrauterine insemination (IUI) in infertile ovulatory women. DESIGN: Retrospective chart review. SETTING: University-based infertility clinic. PATIENT(S): Three hundred thirty-three ovulatory women, grouped by body mass index (BMI) categories, who received superovulation and IUI for treatment of infertility. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S) PRIMARY OUTCOME: cycle fecundity. SECONDARY OUTCOMES: total dose of gonadotropins, serum level of E(2), and number of follicles >or=17 mm on the day of hCG injection. RESULT(S): Adjusted cycle fecundity was not different among BMI groups (underweight: 0.14 [95% CI: {0.07, 0.29}], normal weight: 0.12 [95% CI: {0.09, 0.16}], overweight: 0.17 [95% CI: {0.12, 0.24}], and obese: 0.14 [95% CI: {0.08, 0.23}]). Adjusted total gonadotropin dose (IU/cycle) was greater in obese women than in underweight or normal-weight women. Although the numbers of large follicles were not different, E(2) levels (pg/mL) were lower in obese women than in normal-weight and overweight women. CONCLUSION(S): Our sample of ovulatory infertile women demonstrated that treatment-related cycle fecundity is unaffected by obesity. We conclude that obese, infertile ovulatory women require a greater dose of gonadotropins to achieve similar levels of superovulation than normal, underweight or overweight women.

Adult↗
PubMed2006

No difference in cycle pregnancy rate and in cumulative live-birth rate between women with surgically treated minimal to mild endometriosis and women with unexplained infertility after controlled ovarian hyperstimulation and intrauterine insemination.

OBJECTIVE: The association between infertility and minimal to mild endometriosis is controversial and poorly understood. The clinical pregnancy rate (PR) per cycle after controlled ovarian hyperstimulation (COH) with or without intrauterine insemination (IUI) is reportedly lower in women with surgically untreated minimal to mild endometriosis than in women with unexplained infertility. It is possible that prior laparoscopic removal of endometriosis has a positive effect on the clinical PR after COH and IUI. Therefore, we tested the hypothesis that after COH and IUI the PR per cycle and the cumulative live-birth rate (CLBR) are equal or higher in women with recently surgically treated minimal to mild endometriosis when compared with women with unexplained infertility. DESIGN: A retrospective, controlled cohort study. SETTING: Leuven University Fertility Centre, a tertiary academic referral center. PATIENT(S): One hundred seven women treated during 259 cycles with COH and IUI including patients with endometriosis (n = 58, 137 cycles) and unexplained infertility (n = 49, 122 cycles). All patients with endometriosis had minimal (n = 41, 100 cycles) or mild (n = 17, 37 cycles) disease that had been laparoscopically removed within 7 months before the onset of treatment with COH and IUI. INTERVENTION(S): Controlled ovarian hyperstimulation using clomiphene citrate (23 cycles) or gonadotrophins (236 cycles) in combination with IUI. MAIN OUTCOME MEASURE(S): Clinical PR per cycle and CLBR within four cycles of treatment with COH and IUI. RESULT(S): The clinical PR per cycle was comparable in women with minimal or mild endometriosis (21% or 18.9%, respectively) and in women with unexplained infertility (20.5%). The CLBR within four cycles of COH and IUI was also comparable in women with minimal endometriosis, mild endometriosis, and unexplained infertility (70.2%, 68.2 %, 66.5%, respectively). CONCLUSION(S): The data from our study suggest that COH and IUI shortly after laparoscopic excision of endometriosis is as effective as COH and IUI in patients with unexplained subfertility.

Adult↗
PubMed2006

Use of letrozole versus clomiphene citrate combined with gonadotropins in intrauterine insemination cycles: a pilot study.

OBJECTIVE: To compare the clinical outcomes between letrozole and clomiphene citrate (CC) in gonadotropin-combined intrauterine insemination (IUI) cycles. DESIGN: Prospective pilot study. SETTING: One university hospital and two private infertility clinics. PATIENT(S): Ninety-three infertile couples eligible for superovulation and IUI. INTERVENTION(S): A letrozole dose of 2.5 mg/day (n = 66) or a CC dose of 100 mg/day (n = 27) was given on day 3-7 of the menstrual cycle, combined with human menopausal gonadotropin (hMG) at a dose 150 IU every other day starting on day 5. MAIN OUTCOME MEASURE(S): The number of mature follicles, serum estradiol (E2) and progesterone (P) levels, endometrial thicknesses on the day of human chorionic gonadotropin (hCG), and clinical pregnancy rates. RESULT(S): The patients' clinical characteristics were comparable between the two groups. The number of mature follicles (3.2 +/- 1.7 vs. 5.6 +/- 2.4) and serum E2 levels on the day of hCG (231.0 +/- 179.8 vs. 1,371.7 +/- 750.5 pg/mL) were significantly lower in the letrozole group. No significant differences were found in endometrial thickness measured on the day of hCG or clinical pregnancy rates (18.2% vs. 25.9%). The rate of patients with serum P levels > 1.0 ng/mL on the day of hCG was significantly lower in the letrozole group (4.5% vs. 25.9%). CONCLUSION(S): Letrozole produced a comparable pregnancy rate vs. CC in gonadotropin-combined IUI cycles. Our results should be confirmed in larger populations with proper randomization.

Adult↗
PubMed2006

Human chorionic gonadotropin administration vs. luteinizing monitoring for intrauterine insemination timing, after administration of clomiphene citrate: a meta-analysis.

OBJECTIVE: To systematically compare hCG administration as a method for intrauterine insemination (IUI) timing with conservative urinary LH surge detection in infertility treatment. DESIGN: Meta-analysis of prospective and retrospective trials. SETTING: Tertiary fertility and IVF center. PATIENT(S): One thousand four hundred sixty-one patients who received hCG after a clomiphene citrate regimen, compared with 1,162 patients who had an LH surge detection for IUI timing. INTERVENTION(S): Both MEDLINE and Cochrane Collaboration were searched. References of retrieved articles were included in the search. The meta-analysis included all controlled trials examining the effectiveness of hCG administration before IUI on clinical-pregnancy rates in comparison with LH detection. Two independent reviewers performed data extraction. MAIN OUTCOME MEASURE(S): Pregnancy rates. RESULT(S): Seven studies with 2,623 patients were included in the meta-analysis (1,461 patients received hCG, and 1,162 had LH surge detection). When all studies were combined, patients who received hCG before IUI demonstrated lower clinical-pregnancy rates than did women who had IUI after spontaneous ovulation (odds ratio, 0.74; 95% confidence interval, 0.57-0.961). In subgroup analysis of studies that considered ovulatory dysfunction to be the infertility reason, the results favored women who received hCG. In contrast, across studies that reported male factor as the infertility reason, as well as across studies including women with unexplained infertility, results appeared to favor the LH surge detection approach. However, none of those subgroup analyses reached statistical significance. CONCLUSION(S): Available data do not demonstrate a consistent, clinically important benefit of hCG-induced ovulation compared with spontaneous ovulation for IUI timing.

Adult↗
PubMed2004

[Intrauterine insemination: spontaneous or medically-assisted ovulation?].

Intrauterine insemination (i.u.i.) is usually proposed as the first-line therapy for infertility related to cervical factor, male and unexplained infertility. The overall success rate of i.u.i. is about 10-20% clinical pregnancies per cycle. i.u.i. may be performed in patients with or without prior controlled ovarian hyperstimulation (COH). The aim of COH is to closely monitor follicular growth in order to achieve a timely triggering of ovulation and i.u.i. Additionally, ovarian stimulation allows to increase the number of developing follicles. According to the review of previous prospective randomized studies and meta-analyses, it seems that: (i) when a cervical factor is involved, the advantage of COH in conjunction with i.u.i. is likely but has to be confirmed; (ii) in male infertility, COH with gonadotropins in conjunction with i.u.i. increases the clinical pregnancy rate by two. In this situation, the better the sperm parameters are, the more advantageous COH is; (iii) in unexplained infertility, COH in addition to i.u.i. improves the pregnancy rate but stimulation with clomifene citrate appears to be less effective than gonadotropins administration. Beside the sperm parameters, the success rate depends on both woman's age and degree of ovarian stimulation. Meanwhile, ovarian hyperstimulation exposes to the risk of multiple pregnancy and hyperstimulation syndrome. Increasing the number of preovulatory follicles from one to two allows to approximately double the pregnancy rate. However, there is clear evidence that getting three or more than three follicles exposes to a worrying risk of multiple pregnancy. At the present time, the successful outcome of i.u.i. should not be assessed by the clinical pregnancy rate any longer but by the singleton birth rate. Our therapeutic strategy for COH prior to i.u.i. should take into account woman's age, infertility duration and associated infertility factors. The objective in terms of preovulatory follicle number must be determined prior to the stimulation in order to optimise the cycle outcome with a singleton birth.

Adult↗