Single Versus Double Intrauterine Insemination in Controlled Ovarian Stimulation Cycles for Subfertile Males

Abstract

This study aimed to compare the efficacy of single intrauterine insemination (IUI) with double IUI in controlled ovarian hyperstimulation (COH) and IUI cycles for subfertile males. This is a prospective, nonrandomized study in hospital based outpatient infertility center. The subfertile males were diagnosed by at least two sperm analyses. The study included ovulatory women having patent tubes and undergoing COH cycles with either single or double IUI. Controlled ovarian hyperstimulation was induced by either clomiphene citrate (CC) with gonadotropins or only gonadotropins. Intrauterine insemination of husband's sperm was performed 36 hours after hCG administration in single IUI group. In the double IUI group, first IUI was performed 12-18 hours and second IUI 36 hours after hCG administration. The decision as to which intervention group a patient was placed in was determined by the day of hCG administration. Ovarian response to hyperstimulation was the only factor influencing the day of hCG administration. Statistical analyses was carried out by using the student's t test and chisquared test. The main outcome measure is Clinical Pregnancy rate (CPR). Pregnancy was determined ultrasonographically by the presence of fetal cardiac activity. A total of 191 couples underwent 216 COH-IUI cycles; 110 couples underwent 124 cycles with single IUI and 81 couples underwent 92 cycles with double IUIs. Cycle pregnancy rates were 9.2% (12/124) in the single IUI group and 8.2% (9/92) in the double IUI group, respectively (p=0.782). It is concluded that a single IUI may be as effective as double IUI for couples undergoing COH/IUI for subfertile males.