EVALUATION OF CLOMIPHENE CITRATE AND HUMAN CHORIONIC-GONADOTROPIN TREATMENT - A PROSPECTIVE, RANDOMIZED, CROSSOVER STUDY DURING INTRAUTERINE INSEMINATION CYCLES

Objective: To test the hypothesis that in couples undergoing IUI, acti vely managed cycles using clomiphene citrate (CC) stimulation, ultraso und monitoring, and hCG timing will result in increased pregnancy rate (PR) per cycle compared with unstimulated urinary LH-timed cycles. Pa tients: Fifty-six couples with unexplained infertility (n = 26) or mal e factor infertility (n = 30) participated in the study. Setting: Tert iary academic medical center. Design: Prospective, randomized, crossov er. Couples were randomized initially to one of the two study groups ( treatment A: LH-timed IUI; treatment B: CC-stimulated, hCG-timed IUI). If no pregnancy occurred, each couple alternated between the two regi mens during subsequent cycles, up to a total of four cycles. Results: Twenty-nine couples completed the study and the analysis of 95 cycles revealed that among the male factor infertility group, one pregnancy o ccurred during the 26 cycles of each treatment group (PR per cycle of 3.9% for both treatment groups). In contrast, among the unexplained in fertility group, there was a marked difference in the effect of treatm ents. During treatment A only one pregnancy occurred in 20 cycles (PR of 5% per cycle) whereas during treatment B, six pregnancies occurred in 23 cycles (PR of 26.1% per cycle). Conclusions: If IUI is chosen as the treatment modality in unexplained infertility, the addition of ac tive ovulation management that includes CC stimulation, ultrasound mon itoring of folliculogenesis, and hCG timing of ovulation increases the PR per cycle. In couples with mere infertility, PR per cycle is low a nd is apparently not affected by the addition of active ovulation mana gement.