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, University of Milan. Patient(s): Patients with male factor and unexplained infertility undergoing controlled ovarian hyperstimulation (COH) and IUI. Intervention(s): After COH with clomiphene citrate and gonadotropins, patients 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 pregnancy rate. Result(s): Two hundred seventy-three patients underwent 449 treatment cycles: 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 pregnancies 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 significant difference between group B and groups A and C. Conclusion(s): Our data indicate that two IUIs performed 12 hours and 34 hours after hCG administration is the most cost- effective regimen for women undergoing COH cycles with clomiphene citrate and gonadotropins. Although the second insemination adds up to a slightly higher cost, it significantly increases the chance of pregnancy.