Efficacy of double intrauterine insemination in controlled ovarian hyperstimulation cycles

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.).