Fallopian tube sperm perfusion (FSP) versus intra-uterine insemination (IUI) in the treatment of unexplained infertility: a prospective randomized study

Abstract

Prospective randomization of 60 couples with unexplained infertility was performed for treatment either with intrauterine insemination (IUI), using a volume of 0.5 ml of the inseminate, or Fallopian tube sperm perfusion (FSP), using a volume of 4 ml of inseminate. The protocols for ovarian stimulation and induction of ovulation were the same in the two groups. The two groups were similar concerning age of the female at the start of treatment and the number of follicles > 15 mm diameter, the serum oestradiol concentrations and the endometrial thickness on the day of human chorionic gonadotrophin (HCG) administration. The mean (+/- SD) number of motile spermatozoa inseminated was significantly higher in the FSP group than in the IUI group (52 +/- 5 x 10(6) and 28 +/- 3 x 10(6) respectively). In the FSP group, 30 women were given a total of 52 treatment cycles; 14 clinical pregnancies occurred in this group, giving a pregnancy rate of 26.9% per cycle and 46.7% per woman. In the IUI group, 28 women were given a total of 51 treatment cycles; five clinical pregnancies occurred, giving a pregnancy rate of 9.8% per cycle and 17.9% per woman. The pregnancy rates per cycle and per woman in the FSP group were significantly higher than in the IUI group (P < 0.05, chi-square test). This study indicates that in the treatment of couples with unexplained infertility, Fallopian tube sperm perfusion (FSP) is more successful than intra-uterine insemination (IUI).

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

“…In some other studies where couples with unexplained infertility were treated with FSP, Kahn et al [6,7] found a pregnancy rate per cycle of 27-29%. We were not able to confirm these rates as we obtained a preg nancy rate per cycle of only 14.5%, quite similar to the IUI rate.…”

“…Others state that the prob ability of obtaining a pregnancy is very low when < 10 x 106 motile spermatozoa are inseminated [3]. Kahn et al [6,7], pioneers in FSP, believe that the use of an insemi nate of 4 ml provides a flushing through the fallopian tubes to the pouch of Douglas and so the presence of sper matozoa in the whole female genital tract increases the possibility for conception. Our study failed to demon strate any benefit from the use of FSP suggesting that IUI and FSP are equally effective in the treatment of couples with unexplained infertility.…”

“…An Allis clamp was placed on the cervix to prevent reflux, and the insemination was performed very slowly. The clamp was kept in place for 3-4 min after the insemination (ac cording to Kahn et al [7]). The woman rested in bed for 20 min after the insemination by either IUI or FSP.…”

“…The cycle fecundity is positively correlated with the post-swim-up concentration of spermatozoa and the total number of motile spermatozoa inseminated [3], The most common inseminated volume is 0.2-0.5 ml [4,5], Some investigators recently stated that they could ensure a large number of motile spermatozoa at the ovulation site by increasing the insemination volume up to 4 ml [6], By using ovarian stimulation and fallopian tube sperm perfu sion (FSP) they obtained results much better than those obtained with IUI [7],…”

Assisted Reproduction

“…The aim of this technique is to achieve a higher concentration of motile spermatozoa within the lumen of the Fallopian tube in order to increase the probability of fertilization. One particular modifi cation of intrauterine insemination involves the perfusion of a larger volume of a prepared sperm sample (4 ml) over a period of 4 min into the uterine cavity, to ensure the attachment of a larger number of spermatozoa to the mucosa of the Fallopian tube (Kahn et al 1993). Later prospective studies and a single meta-analysis showed higher pregnancy rates in couples with unexplained infertility only (Trout and Kemmann 1999).…”