الفهرس 
History Of Artificial InseminationOnly 14 pages are availabe for public view
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Abstract
Most couples seeking infertility treatment do not have problems rendering them completely unable to conceive. Rather, the couples have conditions associated with a relative decrease in the monthly likelihood of conception in which pregnancy can occur without treatment. Examples of subfertile conditions include unexplained infertility.
For all couples, the natural age related decline in fertility is also . present regardless of the case of their reproductive problems. This biological clock is to significant issue for many couples, paralleling the demographic trend towards later marriage and childbearing.
As a consequence, patients and their physicians have gradually focused their efforts on newer options such as assisted reproductive technology, which may offer a non specific enhancement of cycle fecundity. The real issue is when these options can be used in a cost —effective manner.
Controlled ovarian hyperstimulation combined with intrauterine insemination of capacitated sperms has recently been used to treat a subtle of infertile couples in the absence of mechanical compromise of pelvic viscera, in whom no other efficacious treatment options exist.
The aim of this study was to evalu,ke the relationship between the follicular response (follicular diameter) to ovulation induction agents, and pregnancy among women with unexplained infertility undergoing IUI.
Su►►ar And Conclusion
The study was designed as a prospective controlled cross over study and carried on the infertile couples attending the cynecdogy clinic of Benha University Hospital during the period from September 2003 to June 2004.
Exclusions criteria included wife age above 35 years, and women with medical disorders which may contraindicate or be complicated with pregnancy as liver diseases, renal diseases, diabetes mellitus, thyrotoxicosis, epilepsy ... etc.
The protocol of ovarian stimulation was clomiphene citrate from day 3-7 and single dose hMG given on day 9. Ultrasound monitoring started from day 9 and every other day. When one of the follicle is 16-23 mm endometrial thickness is recorded, then 10.000 IU hCG is given IM (according to the group, either when MFD 16-19.99m or when MFD> 20mm), insemination was performed 34 hours later.
Sperm processing was done by the swim —up technique using Ham’s F10 media. 0.4 ml of the supernatant containing active sperms is used directly for IUI by Seminor R catheter.
Micronized oral progesterone was given for Iuteal phase support in
a dose of 200 mg for 10 days. Pregnancy was diagnosed by detection of • serum B subunit hCG and confirmed later by TV U/S examination.
A total of 154 inseminations were done in six treatment cycles 76 were IUI with MFD < 20mm and 78 were IUI with MFD > 20mm.
A total of 7 pregnancies occurred giving an overall pregnancy rate per patient of 33.33% and per cycle of 4.54%. the higher pregnancy rate occurred when hCG is given with MFD 16-19.99 (40% and 7.89%) and the lower pregnancy rate occurred when hCG was given with MFD> 20mm (6.66% and 1.28%).
Pregnant cases had no significant younger age and shorter duration of infertility. There were no significant difference between pregnant and non pregnant cases in relation to the number of follicles 16-23 mm, endometrial thickness recorded on the day of hCG injection.
The swim-up technique used for ’sperm processing significantly increase sperm concentration and increases sperm progressive motility,
In normospermic husbands no difference in sperm parameters was found between pregnant and non pregnant cases.
No complications were recorded during our work. Minor side effects included difficult application in 3 cases and sperm reflux in 2 cases and obdominal cramp in 1 cases of IUI. .
We achieved 7 cases of pregnancy, out of which 6 cases, were single pregnancy and one cases of twin pregnancy.
Comparison between the number of pregnancy after IUI with MFD < 20 and IUI with MFD > 20 shows that women with MFD > 20mm were less likely to get pregnant (6.66% per patient and 1.28% per cycle) as compared to women with MFD 16-19.99 (40% and 7.89%).
We can conclude form our study the following remarks:
1.IUI is better done when hCG is given with MFD 16-19.99mm rather than when given with MFD > 20 aiming for better pregnancy rate.
2.CC and single dose gonadotrophin for ovarian stimulation is of low cost with minimal side effects and needs no sophisticated hormonal follow up beside its low cost, so it is suitable in our centers.
3.Higher pregnancy rate in COH-IUI is obtained in the first 3 treatment cycles.
4.In IUI, no complications occur but only minor tolerable side effects may happen.
5.In COH-IUI with minimal stimulation protocol, pregnancy is mostly single.
Recommendation:
Results of IUI are promising when hCG is given with mean follicular diameter is 16-19.99 mm rather than, when it is > 20 mm and so it showed be considered in IUI program, aiming to obtained higher pregnancy rate.