Immobilisation versus immediate mobilisation after intrauterine insemination: randomised controlled trial

Abstract

Objective To evaluate the effectiveness of 15 minutes of immobilisation versus immediate mobilisation after intrauterine insemination. Design Randomised controlled trial. Setting One academic teaching hospital and six nonacademic teaching hospitals. Participants Women having intrauterine insemination for unexplained, cervical factor, or male subfertility. Interventions 15 minutes of immobilisation or immediate mobilisation after insemination. Main outcome measure Ongoing pregnancy per couple. Results 391 couples were randomised; 199 couples were allocated to 15 minutes of immobilisation after intrauterine insemination, and 192 couples were allocated to immediate mobilisation (control). The ongoing pregnancy rate per couple was significantly higher in the immobilisation group than in the control group: 27% (n=54) versus 18% (34); relative risk 1.5, 95% confidence interval 1.1 to 2.2 (crude difference in ongoing pregnancy rates: 9.4%, 1.2% to 17%). Live birth rates were 27% (53) in the immobilisation group and 17% (32) in the control group: relative risk 1.6, 1.1 to 2.4 (crude difference for live birth rates: 10%, 1.8% to 18%). In the immobilisation group, the ongoing pregnancy rates in the first, second, and third treatment cycles were 10%, 10%, and 7%. The corresponding rates in the mobilisation group were 7%, 5%, and 5%.

Efficacy of passive uterine straightening during intrauterine insemination on pregnancy rates and ease of technique

“…However, the main drawbacks of this technique are possible time wasted while waiting for the bladder to fill and patients' stress due to urgent urination need or early mobilization to urinate after IUI procedure. In addition, the evidence that immobilization for 15 min after IUI increase the pregnancy rate might be argued 6 . However, sharing the knowledge that pregnancy rates were improved with passive uterine straightening, and by emptying the bladder with a Foley catheter after IUI, may encourage patients who have difficulty tolerating the technique.…”

“…In addition, the evidence that immobilization for 15 min after IUI increase the pregnancy rate might be argued. 6 However, sharing the knowledge that pregnancy rates were improved with passive uterine straightening, and by emptying the bladder with a Foley catheter after IUI, may encourage patients who have difficulty tolerating the technique.…”

Donor Insemination

“…Several randomized studies suggest that pregnancy rates may be increased if the woman remains lying down on the examination table for 10-15 min [ 27 ]. A prospective, randomized trial of women treated with clomiphene and IUI found that subjects who remained supine for 10 min after insemination had higher per cycle pregnancy rates (4.4 % vs. 13.3 %) and three-cycle cumulative pregnancy rates (10 % vs. 29 %) [ 28 ].…”

The role of intrauterine insemination in male infertility

“…Saleh et al (2000) reported that if a woman remained in a supine position for 10 min after IUI, the pregnancy rates increased significantly compared with immediate mobilization (13% vs. 4% per cycle). A more recent, larger study by Custers et al (2009) showed that immobilization for 15 min after IUI significantly increased ongoing pregnancy and live birth rates compared to immediate mobilization (OPRs 27% vs. 18%, RR: 1.5, 95% CI, 1.1-2.2; live birth rates 27% vs. 17%, RR: 1.6, 95% CI, 1.1-2.4).…”