A NEW SYSTEM FOR FALLOPIAN-TUBE SPERM PERFUSION LEADS TO PREGNANCY RATES TWICE AS HIGH AS STANDARD INTRAUTERINE INSEMINATION

Objective: To evaluate the relative efficacy of a new system for fallo pian tube sperm perfusion in comparison with standard IUI in controlle d ovarian hyperstimulation (COH) cycles. Design: Prospective randomize d trial. Setting: Ovulation induction program of a tertiary outpatient care center, Hopital Antoine Beclere, Clamart, France. Patients: We s tudied 74 infertile women aged 20 to 38 years undergoing 100 cycles of COH from December 1993 to May 1994 only excluding cases of age >38 ye ars, obstructed or severely damaged fallopian tubes, E(2) levels per m ature follicle <250 pg/mL (conversion factor to SI unit, 3.671) on the day of hCG administration, spontaneous LH surge, and cases of marked sperm abnormalities. Interventions: Controlled ovarian hyperstimulatio n was achieved using three types of ovarian stimulation protocols: clo miphene citrate (CC) and hMG (n = 35), hMG alone (n = 35) or GnRH agon ist and FSH and hMG (n = 30). Thirty-six hours after hCG administratio n, patients were assigned randomly to either IUI (group A, n = 50) or fallopian tube sperm perfusion (group B, n = 50). Intrauterine insemin ation was performed with 0.2 mt of sperm suspension according to a sta ndard technique. Fallopian tube sperm perfusion was performed using a simple and reliable system that ensures a good cervical seal and allow s to a pressurized injection of 4 mt of sperm suspension. Main Outcome Measures: Feasibility of the fallopian tube sperm perfusion method, c linical pregnancy (presence of gestational sac with heart beats at 6 w eeks of amenorrhea), and ongoing pregnancy rates (PRs) (>12 weeks of a menorrhea), incidence of complications (multiple pregnancies and ovari an hyperstimulation syndrome [OHSS]). Results: Overall, the new fallop ian tube sperm perfusion system was simple to handle and well tolerate d by patients. In group A, we observed 10 clinical pregnancies (20% pe r cycle) of which 7 were ongoing (14%). In group B, 20 clinical pregna ncies (40% per cycle) of which 17 ongoing pregnancies (34%) were obtai ned. These differences were statistically significant. The prevalence of twin and three or more sac pregnancies was similar in the two group s (3/10 and 0/10, respectively, in group A, and 5/20 and 2/20, respect ively, in group B). No case of moderate or severe OHSS was observed in this series. Conclusions: Our results indicate that the new system fo r fallopian tube sperm perfusion is not only simple and reliable but a lso may lead to PRs twice as high as standard IUI in COH cycles.