Impact of intrauterine insemination as first line treatment of subfertility.

OBJECTIVE To determine the success rate of intrauterine insemination (IUI) in couples presenting with subfertility following controlled ovarian hyperstimulation (COH) by the use of cost effective intrauterine catheter (insertion tube). METHODS An experimental study was conducted at the Obstetric and Gynaecology Departments of Combined Military Hospital Kharian and PNS SHIFA Karachi in collaboration with the Department of Pathology from June 2002 to March 2005. A total of 89 couples were studied, out of which 28 couples presented with abnormal finding in the seminal fluid of husband whereas in 61 couples no identifiable cause could be detected. The mean age of women was 29 years and the duration of infertility was variable. All women had tubal patency confirmed before undergoing COH. IUI was performed at follicular maturity of 18-22 mm. Main outcome measures analyzed were pregnancy rate per cycle of IUI, miscarriage rate and ongoing pregnancy rate. Prognostic factors associated with successful outcome in IUI, such as maternal age and motile sperm count was also observed. For cost effective measures, we used the sterilized disposable insertion tube of the 'Copper-T 380 A' device for insemination of reated sperms into the uterine cavity. Chi-square test was applied to assess the effectiveness of IUI in relation with these variables. RESULTS A total of 205 insemination cycles were performed resulting in achievement of pregnancy in 31 patients. Miscarriage occurred in 3 patients. Out of these 31 women who conceived, 21 (67.7%, p=0.003) were aged < 35 years with higher pregnancy rate per cycle (21 / 90 = 23.3%). CONCLUSION Intrauterine insemination may be regarded as valuable procedure for couples presenting at younger age with lesser duration of infertility and unexplained subfertility.