DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20203313

Comparison of pregnancy outcome between clomiphene citrate and sequential clomiphene citrate+human menopausal gonadotropin in intrauterine insemination

Ankita Singh, Rohan Palshetkar, Namrata Singh, Awyay Rege

Abstract


Background: Intrauterine insemination (IUI) has been widely used as a common treatment for infertile couples. This study compares the sequential clomiphene citrate (CC) treatment with CC and human menopausal gonadotropin (hMG) treatment in women undergoing IUI. Therefore, this study was designed to determine the effects of addition of gonadotropin (CC+hMG) would improve the pregnancy rate in women undergoing IUI. And also compare the sequential CC+hMG treatment with CC treatment in women undergoing IUI.
Methods: A cross-sectional study design was conducted at D. Y. Patil Fertility Centre, D.Y Patil Hospital, Navi Mumbai from September 2018 to August 2019. Source populations were all patients who live in Mumbai, Maharashtra, India. A total of 67 patients were enrolled in this study. (It consisted of 67 sub fertile couples undergoing ovarian stimulation for IUI cycles).
Results: There was no significant difference between the two studied groups regarding endometrial thickness (8.3±2.1 versus 9.7±2.8, respectively), number of mature follicles on the day of hCG injection (3.3±1.2 versus 3.5±1.1, respectively) and, but there was significant difference between the CC+hMG group and CC group regarding the total dose of gonadotropins used in ovulation induction (305±23.8 versus 655±192; total IU, respectively) p<0.05.
Conclusions: Women undergoing IUI, ovarian stimulation CC combined with hMG, significantly improved the pregnancy and live birth rates as compared to that of CC group. In women undergoing ovarian stimulation and IUI, there are no significant differences in pregnancy and live birth rates among the various stimulation protocols.


Keywords


Clomiphene citrate, Human menopausal gonadotropin, Intrauterine insemination

Full Text:

PDF

References


Custers IM, Steures P, Hompes P, Flierman P, van Kasteren Y, van Dop PA, et al. Intrauterine insemination: how many cycles should we perform? Hum Reprod. 2008;23(4):885-8.

McClamrock HD, Jones HW, Adashi EY. Ovarian stimulation and intrauterine insemination at the quarter centennial: implications for the multiple births epidemic. Fertil Steril. 2012;97(4):802-9.

Group ECW. Intrauterine insemination. Hum Reprod Update. 2009;15(3):265-77.

Merviel P, Heraud MH, Grenier N, Lourdel E, Sanguinet P, Copin H. Predictive factors for pregnancy after intrauterine insemination (IUI): an analysis of 1038 cycles and a review of the literature. Fertil Steril. 2010;93(1):79-88.

Oehninger S. Place of intracytoplasmic sperm injection in management of male infertility. The Lancet. 2001;357(9274):2068-9.

Abdelkader AM, Yeh J. The potential use of intrauterine insemination as a basic option for infertility: a review for technology-limited medical settings. Obstet Gynecol Inter. 2009;584837:11.

Katzorke T, Kolodziej FB. Significance of insemination in the era of IVF and ICSI. Der Urologe-Ausgabe A. 2010;49(7):842-6.

Monraisin O, Chansel-Debordeaux L, Chiron A. Evaluation of intrauterine insemination practices: a 1-year prospective study in seven French assisted reproduction technology centers. Fertil Steril. 2016;105(6):1589-93.

The ESHRE Capri Workshop Group. Intrauterine insemination. Human Reprod Update. 2009;15(3):265-77.

Campana A, Sakkas D, Stalberg A, Bianchi PG, Comte I, Pache T, et al. Intrauterine insemination: evaluation of the results according to the woman’s age, sperm quality, total sperm count per insemination and life table analysis. Human Reprod. 1996;11(4):732-6.

Khalil MR, Rasmussen PE, Erb K, Laursen SB, Rex S, Wester gaard LG, Homologous intrauterine insemination. An evaluation of prognostic factors based on a review of 2473 cycles. Acta Obstetricia et Gynecol Scandina. 2001;1(80):74-81.

Kamath MS, Bhave PTK, Aleyamma TK, Nair R, Chandy A, Mangalaraj AM, Muthukumar K, et al. Predictive factors for pregnancy after intrauterine insemination: a prospective study of factors affecting outcome. J Human Reprod Sci. 2010;3(3):129-34.

Tijani HA, Bhattacharya S. The role of intrauterine insemination in male infertility. Human Fertil. 2010;4(13):226-32.

Souter I, Baltagi LM, Kuleta D, Meeker JD, Petrozza JC. Women, weight, and fertility: the effect of body mass index on the outcome of superovulation/intrauterine insemination cycles,” Fertil Steril. 2011;95(3):1042-7.

Soria M, Pradillo G, García J, Ramón P, Castillo A, Jordana C, et al. Pregnancy predictors after intrauterine insemination: analysis of 3012 cycles in 1201 couples. J Reprod Infertil. 2012;13(3):158-66.

Dilbaz B, Ozkaya E, Inar MC. Predictors of total gonadotropin dose required for follicular growth in controlled ovarian stimulation with intrauterin insemination cycles in patients with unexplained infertility or male subfertility. Gynecol Obstet Reprod Med. 20011;1(17):28-33.

Ecochard R, Mathieu C, Royere D, Blache G, Rabilloud M, Czyba JC. A randomized prospective study comparing pregnancy rates after clomiphene citrate and human menopausal gonadotropin before intrauterine insemination. Fertil Steril. 2000;73(1):90-3.

Dankert T, Kremer JA, Cohlen BJ, Hamilton CJ, Pasker-de Jong PC, Straatman H, et al. A randomized clinical trial of clomiphene citrate versus low dose recombinant FSH for ovarian hyperstimulation in intrauterine insemination cycles for unexplained and male subfertility. Hum Reprod. 2007;22(3):792-7.

Berker B, Kahraman K, Taskin S, Sukur YE, Sonmezer M, Atabekoglu CS. Recombinant FSH versus clomiphene citrate for ovarian stimulation in couples with unexplained infertility and male subfertility undergoing intrauterine insemination: a randomized trial. Arch Gynecol Obstet. 2011;284(6):1561-6.

Goverde AJ, McDonnell J, Vermeiden JP, Schats R, Rutten FF, Schoemaker J. Intrauterine insemination or in-vitro fertilization in idiopathic subfertility and male subfertility: a randomised trial and cost-effectiveness analysis. Lancet. 2000;355(9197):13-8.

Honda T, Tsutsumi M, Komoda F, Tatsumi K. Acceptable pregnancy rate of unstimulated intrauterine insemination: a retrospective analysis of 17,830 cycles. Reprod Med Biol. 2015;14:27-32.

The Practice Committee of the American Society for Reproductive Medicine (ASRM). Use of clomiphene citrate in women. Fertil Steril. 2006;86(4):S187-S193.

Akbary-Asbagh F, Heidar Z, Frozan-Fard F, Nouri K, Azmodeh O, Ghasemynejad A, et al. Evaluation of letrozole therapeutic effect in infertile women. Medica Iranica. 2007;45(3):199-203.

Ganesh A, Goswami SK, Chattopadhya R, Chaudhury K, Chakravarty B. Comparison of letrozole with continuous gonadotrophins and clomiphene-gonadotropic combination for ovulation induction in 1387 PCOS women after CC failure: a randomized prospective clinical trial. J Assist Reprod Genet. 2009;26(1):19-24.

Abu Hashim H. Clomiphene citrate alternatives for the initial management of polycystic ovary syndrome: an evidence-based approach. Arch Gynecol Obstet. 2012;285(6):1737-45.

Homburg R, Pap H, Brandes M, Huirne J, Hompes P, Lambalk CB. Endometrial biopsy during induction of ovulation with clomiphene citrate in polycystic ovary syndrome. Gynecol Endocrinol. 2006;22(9):506-10.

Baysoy A, Serdaroglu H, Jamal H, Karatekeli E, Ozornek H, Attar E. Letrozole versus human menopausal gonadotrophin in women undergoing intrauterine insemination. Reprod Biomed Online. 2006;13(2):208-12.

Palomba S, Falbo A, Zullo F. Management strategies for ovulation induction in women with polycystic ovary syndrome and known clomiphene citrate resistance. Curr Opin Obstet Gynecol. 2009;21(6):465-73.

Thessaloniki ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Consensus on infertility treatment related to polycystic ovary syndrome. Fertil Steril. 2008;89(3):505-22.

Steures P, van der Steeg JW, Hompes PG, Bossuyt PM, Habbema JD, Eijkemans MJ, et al. Effectiveness of intrauterine insemination in subfertile couples with an isolated cervical factor: a randomized clinical trial. Fertil Steril. 2007;88(6):1692-6.

Badawy A, Mosbah A, Shady M. Anastrozole or letrozole for ovulation induction in clomiphene-resistant women with polycystic ovarian syndrome: a prospective randomized trial. Fertil Steril. 2008;89(5):1209-12.

Gomez R, Schorsch M, Steetskamp J, Hahn T, Heidner K, Seufert R, et al. The effect of ovarian stimulation on the outcome of intrauterine insemination. Arch Gynecol Obstet. 2014;289(1):181-5.