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INTRA UTERINE INSEMINATION AN EXPERIENCE IN RURAL POPULATION

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DOI: 
0.5958/j.2319-5886.2.3.114
Abstract (2. Language): 
Objective:1) To find out efficacy of various ovulation induction protocols in IUI 2) To find out the efficacy of IUI in treatment of infertility Method: All infertility patients of our OPD underwent a standard investigation protocol The infertility work-up included patients’ history, physical examination, conformation of ovulation by follicular monitoring, tubal patency test by diagnostic laparoscopy, and semen analysis of male partner & PCT. All women underwent a standard treatment protocol that included either natural cycle or ovulation induction to achieve superovulation by clomiphene citrate alone, or combined with gonadotrophins. Follicula monitoring using transvaginal sonography was done from D6-8 onwards and all women were given injection Human chorionic gonadotrophin 5000 U for LH surge when the dominant follicle was ≥18 mm. IUI was Performed at 18 hours and 40 hours from the time of HCG injection. Semen for IUI was prepared by the standard Swim Up technique, or by the Density Gradient method. Progesterone (Transvaginal micronized progesterone 200mg/day) for luteal phase support for 14 days following IUI was given to patients who were affording. Results: Majority of couples were having primary infertility (60.97%) Patients of secondary infertility were of 39.03% only. In our study only 11.82% patients were having multiple factors contributing to infertility. Male factor was in 42.59% of couples as against 30.34% of couples were having only anovulation as causative factor for infertility. Unexplained infertility was present in 13.82% patients only. The outcome variable for success of IUI was occurrence of pregnancy. This was defined by delay in menses associated with presence of positive pregnancy test or a detectable rise in serum beta HCG levels. In our study overall pregnancy rate per cycle was 8.01% & per couple it was 21.65%. Per cycle fecundity according to the factor responsible for infertility, the highest success rate was observed in cervical factor (33.33%). For male factor it was 7.74% and for combined factors overall it was 5.92%. Out of 152 pregnancies that occurred during study 108 had Full Term live birth of the baby (71.05% Miscarriage was there in 9.87% patients only. Only three patients had multiple pregnancies (1.97%) and one patient had ectopic pregnancy. Per cycle fecundity was little better in patients with only anovulation( 10.51%). When we compared various regimen used for ovulation induction for IUI we found that though percentage of pregnancies achieved by Low dose HMG either with (13.89%) or without Clomiohene (15.58%), pregnancy rate achieved with clomiphene alone was 7.43% . This was promising at low affordable cost.In our study, we achieved 40.13% pregnancy with second attempt and collectively with first two attempts pregnancy rate achieved was 71.71%.
FULL TEXT (PDF): 
341-349

REFERENCES

References: 

1. Allahabadia G.N. & Merchant R. Chapter
N031. Intrauterine insemination. Edited by
Zsolt Peter Nagy, etal. Practical manual of in
vitro fertilization. First Indian reprint 2013.
Published by Springer New Delhi. Page no
282.
2. Pterson CM, Hatasaka HH, Jones KP, et al.
Ovulation induction with gonadotrophins and
intrauterine insemination compared with
invitro fertilization and no therapy. A
prospective nonrandomized cohort study and
Meta analysis. Fertil. Steril. 1994;62:535-44
347
Sarita AD et al., Int J Med Res Health Sci. 2013;2(3):341-349
3. RCOG. The management of infertility in
secondary care. (Evidance based clinical
guidelines, No.3) London:RCOG press, 1998.
4. Dodson WC and Haney AF. Controlled
ovarian hyperstimualrion and Intra uterine
insemination for treatment of infertility. Fertil
steril 1991; 55:457-67.
5. Steures P, van der Steeg JW, Mol BW et al.
Prediction of an ongoing pregnancy after
intrauterine insemination. Fertil Steril
2004;82(1):45-51
6. IbericoG,Vioque J. Auza N. Et al.Analysis of
factors influencing pregnancyrates in
homologous intrauterine insemination. Fertil.
Steril. 2004;81:1308-13
7. Shibahara H,Obara H, Ayustawati et al.
Prediction of pregnancy by intrauterine
insemination using CASA estimates and
strict criteria in patients with male factor
infertility. Int. J. Androl. 2004; 27:63-8.
8. Chen L, Liu Q. (Natural cycle versus
ovulation induction cycle in intrauterine
insemination) (Article in Chinese). Zhonghua
Nan Ke Xue. 2009; 15(12: 1112-5.
9. Custers IM, Steures P, Hompes P, Flierman
P, van Kasteren Y, van Dop PA, Intrautrine
insemination: How many cycles should we
perform? Hum Reprod. 2008:23(4):885-8.
10. Aboulghar M, Baird DT, Collins J, et
al.ESHRE Capri Workshop Group.
Intrauterine insemination. Hum Reprod
Update. 2009; 15(3): 265-77.
11. Krzysztof L. Optimizing stimulation
protocols In:Allahabadia GN et al editor.
Contemporary perspective in assisted
reproductive technology. India: Reed
Elsevier; 2005.p.10-7.
12. Kabli N, Sylvestre C, Tulandi T, et
al.Comparision of daily and alternate day
recombinanat FSH stimulation protocol for
IUI. Fertil Steril. 2009; 91(4):1141-4.
13. ShekarrizM, Steures P, et al. Methods of
human semen centrifugationto minimize the
iatrogenic sperm injuries caused by reactive
oxygen species. Eur Urol. 1995; 28(1):31-5.
14. ErdemA, Erdem M, Atmaca S, et al. Impact
of luteal phase support on pregnancy rates in
IUI cycles: a prospective randomized study.
Fertil Steril 2009; 91(6) : 2508-13.
15. Silverberg KM, Johnson JV, Burns WN, et
al. A prospective randomized trial comparing
two different IUI regimens in controlled
ovarian hyperstimulation cycles. Fertil Steril,
1992; 57:357-361.
16. Tougc E, Var T, Onalan, et at. Comparisons
of the effectiveness of the single vursus
double IUI with three different timing
regimens.Fertil Steril. 2010; 94:1267-70.
17. Khalil MR, Rasmussen PE, Erb K et al.
Homologous IUI. An evaluation of
prognostic factors based on a review of 2473
cycles. Acta Obstet gynecol Scand 2001; 80:
74-81
18. Morshedi M, Duran HE, et al. Efficacy and
pregnanacy outcome two methods of semen
preparation for IUI: a prospective randomized
study. Fertil Steril. 2003; 79 Suppl 3: 1625-
32.
19. Morshedi M, Duran HE, Taylor S, Et al.
Efficacy and pregnancy outcome of two
methods of semen preperationfor IUI: a
prospective randomized study. Fertil Steril
2003;79 Suppl 3:1625-32
20. Tay PY, Raj VR, et. Al. Prognostic factors
influencing pregnancy rate after stimulated
IUI. Med J Malaysia. 2007; 62(4): 286-9
21. Yalti S,Sezer H, Celik, Effects of semen
characteristics on IUI combined with mild
ovarian stimulation. Arch Androl.
2004;50(4): 239-46
22. GuvenS, Gunalp GS, Tekin Y. Factors
influencing pregnancy rates in IUI cycles. J
Reprod Med. 2008:53(4): 257-65
23. OmbeletW, Deblaere K, et al. Semen quality
and IUI. Reprod Biomed Online.
2003:7(4):485-92
347
348
Sarita AD et al., Int J Med Res Health Sci. 2013;2(3):341-349
24. AribargA, SukcharoenN, IUI of Washed
Spermatozoa for treatment of
oligozoospermia. Int J Androl. 1995;18suppl
1 : 62-6
25. BillietK, Dhont M, Vervaet C, et al. A
multicenter prospective, randomized, double
blind trial studying the effect of mesoprostol
on the outcome of IUI. Gynecol ObstetInvest.
2008:66(3) :145-51
26. Zadehmodarres S, Oladi B, et al.IUI with
husband semen: an evaluation of pregnancy
rate and factors affecting outcome. J Assit.
Reprod Genet. 2009; 26(1) : 7-11
27. Sacks PC, Simon JA, Infectious
complications of IUI. a case report and
literature review. INT J Fertil. 1991;36(6) :
331-9
28. Bensdorp A J, Cohlen BJ et al. IUI for male
subfertility. CochraneDatabase Syst Rev.
2007;(4):CD000360
29. Check JH, Bollendorf A, et al.IUI for cervical
and male factor without super ovulation.
Arch Androl. 1995;35(2):135-41
30. Steures P, van der Steeg JW, et al Does
Ovarian hyper stimulation in IUI for cervical
factor subfertility improve pregnancy rates?
Hum Reprod. 2004:19(10) : 2263-6

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