CONTROLLED OVARIAN HYPERSTIMULATION AND TRANSVAGINAL INTRATUBAL INSEMINATION AS AN ALTERNATIVE TO GAMETE INTRAFALLOPIAN TRANSFER

Objective: To evaluate the efficacy of controlled ovarian hyperstimula tion (COH) followed by intratubal insemination in the treatment of inf ertility. Design: Retrospective analysis of 179 intratubal inseminatio n trials in 78 women over a 48-month period. Setting: Reproductive end ocrinology practice. Patients: Seventy-eight women, 26 to 44 years old (34 +/- 4.3 years; mean +/- SD), classified into subgroups according to diagnosis and age (<40 or greater than or equal to 40 years). Inter ventions: Patients underwent COH and intratubal insemination. Main Out come Measures: The rates of pregnancy, delivery, spontaneous abortion, ectopic and multiple gestation, and complications were studied and an alyzed statistically. Results: Overall, there were 36 pregnancies (20. 1% of 179 trials), 29 deliveries (16.2%), 5 of 36 first trimester abor tions (13.9%), 2 of 36 ectopic pregnancies (5.6%), and 4 twin gestatio ns. There were no serious complications. In 43 women < 40 years withou t male factor the first trial resulted in 15 pregnancies (34.9%); in 2 7 women < 40 years with male factor the first trial resulted in 4 preg nancies (14.8%). Male factor reduced significantly the probability of conception. In 19 women < 40 years of age with either ovarian dysfunct ion or infertility of unknown cause, the first trial resulted in 9 pre gnancies (47.4%), which was significantly better than the 10 pregnanci es achieved in the first trial in the remaining 51 women < 40 years of age. Peak serum E(2) levels and number of mature follicles had a sign ificant effect on pregnancy rates. Conclusions: Intratubal inseminatio n yielded pregnancy rates comparable to those published for GIFT at re duced cost and with fewer complications.