P-52: Controlled Ovarian Hyperstimulationand Intrauterine Insemination Cycles in Patientswith Unilateral Tubal Blockage Diagnosed byHysterosalpingography

Background: Tubal pathology ranks among the most frequent causes of subfertility, next to ovulatory disorders and sperm defects .There fore , assessment of tubal patency is a fundamental part of infertility workup. Investigation for tubal disease can be divided into radiological tests: hysterosalpingography (HSG) , selective salpingography and hystero-contrast-sonography (HyCoSy) , microbiological tests: Chlamydia testing of the serum or urine and surgical tests: laparoscopy with chromopertubation, falloscopy; fertiloscopy.Although, diagnostic laparoscopy is generally accepted as the most accurate procedure to detect tubal pathology and periadnexal adhesions and endometriosis owing to the noninvasive nature and low cost, HSG is widely used as a first-line approach to assess uterine anatomy and tubal patency in routine infertility workup. HSG has 65% sensitivity and 83% specificity for tubal obstruction .A good correlation between HSG and laparoscopy regarding tubal patency has demonstrated.There is a growing tendency to by pass diagnostic laparoscopy in couples with a normal HSG(patent tubes) who will undergo intrauterine insemination (IUI) treatment for unexplained infertility (UEI), mild male subfertility and cervical hostility . Management of the patients with unilateral tubal blockage diagnosed by HSG is controversial subject. Although, a number of reports recommended laparoscopy and dye test to confirm or refute the diagnosis,then reconstructive tubal surgery by laparoscopy, selective salpingography and tubal catheterization (SS/TC) or hysteroscopic transcervical tubal cannulation .The otherpractitioners suggested that one-sided tubal pathology does not influence the possibility of treatment independent pregnancy .and suggested that laparoscopy may be omitted in women with normal HSG or suspected unilateral tubal pathology on HSG ,since it was not shown to change the original treatment plan indicated by HSG in 95% of the patients,and showed that bilateral tubal pathology diagnosed at HSG or laparoscopy did affect fertility prospects strongly ,whereas unilateral pathology affected future fertility less severely,and recommended controlled ovarian hyperstimulation (COH) and IUI as the initial treatment of choice in patients with unilateraltubal occlusion diagnosed by HSG.So far, only one retrospective study with relative small sample size has tried to evaluate pregnancy rates after COH and IUI in women with HSG findings suspicious to unilateral tubal occlusion .Thus we decided to carry out a prospective study to assess the therapeutic value of COH and IUI in these patients. Materials and Methods: Cross-sectional analysis, between October 2006 and October 2009.In a Academic reproductive endocrinology and infertility center,Mirza Koochak Khan.Two groups of patients undergoing stimulated IUI cycles were compared. Sixty-four unfertile couples with unilateral tubal blockage diagnosed by HSG as the sole cause of infertility in the study group, and two hundred couples with unexplained infertility in the control group. The patients underwent 3 consecutive ovarian hyperstimulation (Cl miphen citrate and human Menopausal Gonadotropin) and IUI cycles.Results: Demographic data were found to be homogenous between the study and control groups. Cumulative pregnancy rates were similar in the study group (26.6%) and the control group (28%) (p=0.823; OR=1.075; 95% CI: 0.57 -2.28). The cumulative pregnancy rate in subgroup with mid-distal tubal blockage (16%) was not statistically lower than subgroup with proximal tubal blockage (33%) (p=0.15; OR= 2.625; 95% CI=0.745-9.25).The cumulative pregnancy rate in subgroup with mid-distal tubal blockage (16%) was lower than the patients with unexplained infertility (28%), the difference was not statistically significant (p=0.209; OR=2.042; 95% CI=0.671-6.213). Conclusion: Controlled ovarian hyperstimulation and IUI could be recommended as the initial treatment in sub- fertile couples with unilateral tubal blockage as the sole cause of infertility.