Optimal timing of IUI

Tansu KÜÇÜKGATA

ANKARA

Cx

Natural fecundability

 CycleNumber of womentrying to conceive

at start of each cycle

Number of pregnancies in study

cycle

Per cycle pregnancy

rate

1 200 59 0.30

2 137 41 0.30

3 95 16 0.17

4 78 12 0.15

5 66 14 0.21

6 52 4 0.08

7 48 5 0.10

8 43 3 0.07

9 40 2 0.05

1 38 1 0.03

11 37 2 0.05

12 35 1 0.03

Zinaman et al, Fertil Steril 1996

Likelihood of pregnancy

85%

Male factor

Female’s age (reserve!)

Expectant management

• One year : 14-20% • Eimers et al. 1994

• Two years: 25-30% • Collins et al. 1995

• Three years: 60-80% • Hull et al 1985; Guzick et al. 1998

• Five years: 80% • Randolph 2000

• Nine years: 64% of primary; 79% of secondary unexplained infertility

• Jaffe and Jewelewicz 1991

• it is usually accepted that a 10% success is reasonable for an IUI treatment combined with controlled ovarian stimulation.

Ragni et al. Fertil Steril 2004

Prognostic fact

Indication

COS

# of insemination

Timing

Semen preparation

Semen qualityPostprocedure rest

confounding factors

IUI

Mis-Timing

In stimulated cycles, ovulation usually occurs 36 hours after hCG administration.

– Edwards & Steptoe. Proc R Soc Med 1974

Double shot

• Cantineau et al. Cochrane Database of Systematic Reviews 2007, Art No: CD005356

• Osuna et al. One versus two inseminations per cycle in intrauterine insemination with sperm from patients’ husbans: a systematic review of the literature. Fertil Steril 2004

J Assist Reprod Genet, 2008

Intrauterine insemination: are we doing at the right time?

Tansu KüçükReceived: 20 January 2008 / © Springer Science + Business Media, LLC 2008

AbstractPurpose To assess whether the timing of intrauterine insemination (IUI) in relation to the rupture of the dominant follicle affects the probability of pregnancy rate after IUI.Material and method Retrospective cohort study. Two hundred ninety-six couples with unexplained infertility and one hundred twenty-one couples with male factor subfertility. Results of 578 cycles were analyzed retrospectively.

Result Clinical pregnancy rate was 23.5% (64/272) in the group when follicle rupture was observed by ultrasound, while it was only 8.8% (27/306) when follicle rupture was not evident (p<0.001).Conclusion Postponing IUI until observation of follicle rupture may yield a higher pregnancy rate.

Key words IUI, follicle rupture, pregnancy

• Weathersbee PS, Werlin LB, Stone SC. Peritoneal recovery of sperm after intrauterine insemination. Fertil Steril 1984;42:322-325

• Ripps BA, Mihnas BS, Carson SA, Buster JE. Intrauterine insemination in fertile women delivers larger numbers of sperm to the peritoneal fluid than intracervical insemination. Fertil Steril 1994;61:398-400)

LUF

Killick et al, Fertil Steril 1997Qublan et al, Hum Reprod 2006