Addition of gonadotrophin-releasing hormone agonist and/or two inseminations with husband's sperm do not improve the pregnancy rate in superovulated cycles

Background A prospective randomized study was performed to evaluate the add ition of a gonadotropin releasing hormone agonist (GnRH-a) during treatment with human menopausal gonadotropins (hMG) in cycles with artificial insemi nations with husband's washed sperm (AIH). We also compared the pregnancy r ate per cycle after one versus two AIHs. Methods. We designed a 2(2) factorial trial. A total of 172 couples with un explained infertility (n=88), endometriosis (n=39), or cervical (n=24) or m ale (n=21) factors were included, of whom 161 fulfilled the inclusion crite ria and treatment. Eighty-one women were treated with GnRH-a/hMG and anothe r 80 with hMG only, respectively. Results. The pregnancy rates did not differ between the two stimulation pro tocols (12% for GnRH-a/hMG and 9% for hMG). With GnRH-a/hMG more follicles >15 mm (3.4 and 2.4, respectively; p<0.01) and a higher multiple pregnancy rate after 20 weeks of gestation were observed (55% vs. 0%; p<0.05). Eighty -seven women were treated with one AIH, whereas 65 women received two AIHs on two consecutive days. The pregnancy rates were similar in these two grou ps (11% and 9% respectively; n.s.) Conclusion. It is concluded that neither addition of GnKH-a before and duri ng controlled ovarian hyperstimulation nor two AIHs compared with one singl e AIH per cycle has a beneficial effect on the pregnancy rate. However, GnR H-a increases the risk for multiple pregnancies.