Timing of IUI 24 or 48 hours after spontaneous LH peak: a randomized controlled trial.

Christophe Blockeel, Nikos P. Polyzos, Beatrice Ermini, Arianna Riva, Dominic Stoop, Herman Tournaye, Paul Devroey

Research output: Contribution to journalConference paper

Abstract

Introduction: Correct timing of intrauterine insemination (IUI) might optimize
the success rates among infertile couples. In hCG triggered IUI cycles, insemination
may be successfully performed between 24 to 40 hours post hCG. In
natural cycles without hCG trigger, however, no solid evidence exists regarding
the optimal timing of IUI. Given that the duration of LH surge is approximately
12-24 hours, the fertilisation window in spontaneous IUI cycles may even be
narrower compared to hCG induced cycles. The aim of the present trial is to
prospectively evaluate whether performing an insemination 24hours after the
spontaneous LH peak may result in significantly higher ongoing pregnancy
rates compared to 48 hours.
Material and Methods: Since March 2010, 116 patients have been included in
this randomised controlled trial. Randomization was performed using a computer
generated list. Treating physicians were unaware of the time of insemination
until the day of the IUI, since randomization was performed at the time of
spontaneous LH peak by a physician who was not involved in patients' further
management. Spontaneous LH peak was defined as a rise in serum LH levels
greater than 18IU/L in patients with normal LH at day 2 of the menstrual cycle,in combination with a serum progesterone value of <1.2ng/l. Patients' inclusion
criteria were the following: 1. normal FSH on cycle day 3 (female age ? 39 years, 3. a regular menstrual cycle (i.e. 24-35 days), presumed
to be ovulatory. Patients were randomised into two groups: in the early group,
patients underwent IUI in a complete natural cycle 24 hours after the LH peak,
whereas in the late group, the insemination took place after 48 hours. Patients
did not get any luteal support.
Results: Overall, 63 patients were allocated to IUI 24 hours after spontaneous
LH peak and 53 patients were allocated to IUI 48 hours after spontaneous LH
peak. Demographic characteristics, such as age, BMI and basal hormonal values,
did not significantly differ among compared groups.
Pregnancy rates did not significantly differ among compared groups. The
positive hCG rate was 15.9% vs 13.2%, p = 0.69 in early and late insemination
groups respectively. In accordance, comparable were the clinical pregnancy
rates (11.1% vs 9.4, p = 0.77) and the ongoing pregnancy rates (11.1% vs 7.5%,
p = 0.51) between the 2 groups.
Conclusions: According to the preliminary results of this randomised trial,
pregnancy rates are comparable when IUI is performed 24 or 48 hours following
spontaneous LH peak. Nonetheless, further follow up is essential in order
to indecisively conclude that the insemination day after spontaneous LH peak
could be flexible.
Original languageEnglish
Pages (from-to)118
Number of pages1
JournalHuman Reproduction
Volume26
Publication statusPublished - Jul 2011
EventUnknown -
Duration: 1 Jul 2011 → …

Keywords

  • IUI
  • LH

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