Fallopian Tube Sperm Perf usion Has No Advantage over Intra-uterine Insemination when Used in Combination with Ovarian Stimulation for the Treatment of Unexplained Infertility

Abstract

In this prospective randomized study we treated 60 couples with unexplained infertility with a combination of ovarian stimulation and either intrauterine insemination (IUI) or fallopian sperm perfusion (FSP). In the IUI we used a volume of 0.5 ml of inseminate and in the FSP a volume of 4 ml. The demographic characteristics of the patients, the stimulation parameters and the sperm data were not statistically different between the two groups. The pregnancy rate per cycle was 16.2% in the IUI group and 14.5% in the FSP group and the pregnancy rate per woman was 40 and 36.7%, respectively (not statistically different). We conclude that IUI and FSP are equally effective in the treatment of couples with unexplained infertility.

Intra uterine insemination: Limitations in a tertiary care hospital

“…7 The rationale put forward in support of COH and IUI is that ovarian stimulation corrects subtle, unpredictable ovulatory dysfunction with increase probability of conception if increased density of motile spermatozoon is placed close to multiple fertilizable oocytes. 10 The concept of both IUI and IVF is based on the hypothesis that such procedures increase gamete proximity within the reproductive tract thus enhancing chances of conception. The universal preference for IUI has further increased following recommendations of National Institute of Clinical Excellence (NICE), UK which has revised the evidence for assessment and treatment of infertile couples and recommended that the IUI should be offered to couples with infertility because it is as effective as IVF, less invasive and requires fewer resources.…”

“…9 It is thus considered a viable treatment option for male factor infertility, cervical factor and unexplained infertility. 10 Ovulation induction with clomiphene citrate or gonadotrophins (HMG/FSH) and intrauterine insemination (IUI) are often chosen before resorting to IVF. The appropriateness of starting with these low and intermediate intensity treatments is supported by evidence that CC/IUI increases cycle fecundity 2-3 fold and FSH/IUI increases cycle fecundity 3-5 fold over baseline chances of pregnancy.…”

L'insémination tubaire chez la femme a-t-elle un avenir ?

“…Au total, sur dixneuf travaux faisant état d'une expérience des auteurs, ont été dénombrées sept études non randomisées [17][18][19][20][21][22][23] et douze études prospectives randomisées FSP vs IIU [24][25][26][27][28][29][30][31][32][33][34][35].…”

“…Onze autres équipes ont rapporté les résultats d'études randomisées : pour sept d'entre elles la FSP n'apporte pas de supériorité dans les résultats en terme de grossesse [26,27,[29][30][31]33,34] alors que pour quatre autres la technique donne de meilleurs taux de grossesse par rapport à l'IIU classique [25,28,32,35]. Les détails de ces études sont rapportés dans le Tableau 1.…”

Intrauterine insemination versus fallopian tube sperm perfusion in non-tubal infertility

“…6 This volume has been considered sufficient for bilateral passage of the spermatozoa through the fallopian tubes. Theoretically this would increase the density of capacitated spermatozoa near the oocytes and results in the higher pregnancy rates.…”