Abstract
Introduction: Infertility is defined as the inability to conceive after 1 year of regular unprotected intercourse, without use of any contraceptive device or methods. Unexplained infertility means that, couple does not conceived after 1 year of unprotected vaginal sexual intercourse, with basic infertility evaluation shows no obvious abnormality (ASRM, 2006)1. Incidence 15% to 30% of infertile couples (ASRM, 2006)1.
Method: 50 cases of unexplained infertility underwent 93 cycles (max. 2 cycles per patient) of IUI both natural as well as stimulated between Feb 2013 -15. In stimulated cycle, COS was initiated and a single IUI performed after 36 hrs of hCG trigger.
Main Outcome Measures: The primary outcome measured was clinical pregnancy rate per cycle and cumulative pregnancy rate. Predictive factors evaluated were age, duration of infertility, type of infertility, stimulation protocol, AFC, ET, endometrial pattern, no. of preovulatory follicles and pre-post wash count and motility.
Results: The pregnancy rate in first and second cycle was 14% and 20.93%, respectively while cumulative pregnancy rate was 17.20%. Among the predictive factors age 24.69 yrs vs 30.51 yrs (P = <0.001), no. of preovulatory follicles 2.00 vs 1.56 (P = 0.046), endometrial pattern trilaminar vs diffuse PR 33.33% vs 8.12% (P = 0.04) and post wash sperm count (p< 0.001) significantly affected the IUI outcome.
Conclusion: Definitive prognostic factors for predicting success will help in counselling regarding treatment modality. Favourable prognostic factors where age, number of preovulatory follicles, motile sperm count and endometrial pattern. The most important factor of these by far is female age, because of its negative effect on ovarian reserve and oocyte quality. By modi modifying the predictive factors significant effect on outcome. When it comes to cost effectiveness, it has been demonstrated that three cycles of IUI offers the same CPR rate as IVF and remain more cost-effective for unexplained infertility. Finally we can say IUI is clearly an efficient treatment option for unexplained infertility.
Keywords: Clinical pregnancy rate, intrauterine insemination, predictive factors
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DOI: http://dx.doi.org/10.18535/jmscr/v4i2.41
