Objective: To investigate the effectiveness of double IUI and to determine
the optimal timing of IUI in relation to hCG administration.
Design: Prospective randomized study.
Setting: Infertility Center, Department of Obstetrics and Gynecology, Unive
rsity of Milan.
Patient(s): Patients with male factor and unexplained infertility undergoin
g controlled ovarian hyperstimulation (COH) and IUI.
Intervention(s): After COH with clomiphene citrate and gonadotropins, patie
nts were randomly assigned to one of the following groups: group A received
a single IUI 34 hours after hCG administration, group B received a double
IUI 12 hours and 34 hours after hCG administration, and group C received a
double IUI 34 hours and 60 hours after hCG administration.
Main Outcome Measure(s): Number of follicles >15 mm in diameter on the day
of hCG administration, number of motile spermatozoa inseminated, clinical p
regnancy rate.
Result(s): Two hundred seventy-three patients underwent 449 treatment cycle
s: 90 patients were treated for 156 cycles in group A, 92 patients for 144
cycles in group B, and 91 patients for 149 cycles in group C. The overall p
regnancies rates for groups A, B, and C were 13 (14.4% per patient and 8.3%
per cycle), 28 (30.4% per patient and 19.4% per cycle), and 10 (10.9% per
patient and 6.7% per cycle), respectively. There was a statistically signif
icant difference between group B and groups A and C.
Conclusion(s): Our data indicate that two IUIs performed 12 hours and 34 ho
urs after hCG administration is the most cost-effective regimen for women u
ndergoing COH cycles with clomiphene citrate and gonadotropins. Although th
e second insemination adds up to a slightly higher cost, it significantly i
ncreases the chance of pregnancy. (Fertil Steril(R) 1999,72:619-22. (C) 199
9 by American Society for Reproductive Medicine.).