The impact of timing of insemination in relation to ovulation on the cycle pregnancy rate of intrauterine insemination and intrauterine tuboperitoneal insemination in unexplained infertility

Objective: 1 – To compare the cycle pregnancy rate of intrauterine insemination (IUI) to that of intrauterine tuboperitoneal insemination (IUTPI) in unexplained infertility. 2 – To assess the effect of timing of insemination in relation to ovulation on the cycle pregnancy rate of IUI and IUTPI. Design: Prospective randomized study. Main outcome measures: 1 – Cycle pregnancy rate of IUI and IUTPI. 2 – Cycle pregnancy rate of preovulatory and postovulatory insemination. Material and methods: Two groups (A and B), each group included 160 women with unexplained primary infertility. Group A were treated by IUI and group B by IUTPI after controlled ovarian stimulation (COS) with sequential clomiphene citrate and human menopausal gonadotropin. Ovulation was by i.m. HCG. At the time of insemination the occurrence of ovulation was checked by transvaginal sonography. Results: After the first treatment cycle 17 patients of group A (10.62%) and 28 patients of group B (17.50%) had ongoing pregnancies (p = 0.0413). After the second treatment cycle 12 patients of group A (8.39%) and 18 patients of group B (19.63%) had ongoing pregnancies (p = 0.0442). After the third treatment cycle 11 patients of group A (8.39%) and 14 patients of group B (12.28%) had ongoing pregnancies (p = 0.0433). After the three treatment cycles 40 patients of group A (25%) and 60 patients of group B (37.50%) had ongoing pregnancies (p = 0.033) and the overall cycle pregnancy rate of group A was 9.21% and group B 14.81% (p = 0.0324). In group A the cycle pregnancy rate of preovulatory insemination was 7.20% and postovulatory 9.76% (p = 0.041). In group B the cycle pregnancy rate of preovulatory insemination was 17.70% and postovulatory 13.0% (p = 0.0322). Five out of 40 pregnancies (12.5%) in group A, and 4 out of 60 pregnancies (6.60%) in group B were twins (p = 0.0431). Conclusion: In unexplained primary infertility IUPI had significantly higher cycle pregnancy rate than IUI. Cycle pregnancy rate of IUI was significantly higher with postovulatory than preovulatory insemination. Cycle pregnancy rate of IUTPI was significantly higher with preovulatory than postovulatory insemination.