Timing therapeutic donor inseminations in natural cycles: human chorionic gonadotrophin administration versus urinary LH monitoring

Abstract

This cohort study assessed whether timing therapeutic donor sperm inseminations (TDI) in natural cycles (NC) using ultrasound monitoring and ovulation trigger with human chorionic gonadotrophin (US/HCG) improves cumulative live birth rates (LBR) compared with detection of LH surge with urinary kits (u-LH). It included 232 normo-ovulatory women aged ≤40 years, undergoing 538 TDI in NC between 2011 and 2014. In the u-LH group (113 women, 267 cycles), TDI was performed the day following a positive test. In the US/HCG group (119 women, 271 cycles), ovulation was triggered with HCG when a follicle ≥17 mm was noted, and TDI performed 36 h later. The first three cycles were analysed per patient. Groups were comparable for baseline characteristics. Cumulative LBR were comparable between u-LH and US/HCG groups (31.47% versus 23.11%, respectively) (log-rank test). A generalized estimating equation analysis was performed to compare outcomes per cycle. The LBR per started cycle was comparable between the u-LH and US/HCG groups (12.4% versus 9.2%, respectively). Cancellation rate was significantly higher with u-LH (19.1% versus 11.4%, P = 0.011), but did not impact overall outcomes. In conclusion, urinary LH monitoring is as effective as ultrasound monitoring and ovulation trigger with HCG in TDI performed in NC.

Predictive factors for intrauterine insemination outcomes: a review

“…In normo-ovulatory women, IUI may be performed either with a spontaneous LH surge or with a human Chorionic Gonadotropin (hCG) ovulation trigger. Spontaneous LH surge measured in the urine has been compared to administration of an hCG trigger in natural cycles in a retrospective study [ 85 ] and to CC-stimulated cycles in a randomized study [ 86 ]. Both studies found comparable pregnancy rates with urinary LH measurement versus use of an hCG trigger.…”

Effect of HCG-Triggered Ovulation on Pregnancy Outcomes in Intrauterine Insemination: An Analysis of 5,610 First IUI Natural Cycles With Donor Sperm in China

“…A retrospective cohort study by El Hachem et al found no difference in clinical pregnancy or live birth rates between urinary LH monitoring vs. hCG-triggered ovulation in natural unstimulated therapeutic donor sperm insemination cycles ( 11 ). The inclusion criteria of that study were strict: only normo-ovulatory women were included.…”

“…Multiple clinical studies have assessed the effect of hCG on pregnancy outcomes, but have reached inconsistent conclusions (9)(10)(11)(12). Such conflicting results result from clinical indication, female age, baseline characteristics of study participants, sperm quality, timing, or type of ovarian stimulation.…”

The interval between insemination and ovulation predicts outcome after intrauterine insemination with donor sperm (IUI‐D)

“…The timing of insemination is a key factor affecting the outcome after IUI-D [18]. A proper interval from insemination to ovulation (I-O interval) may increase the chance of pregnancy [19]. Several studies have investigated the effects of different insemination time on the pregnancy rate (PR) but have reported inconsistent conclusions [20][21][22].…”