Journal of Advanced Medical Sciences and Applied Technologies

Journal of Advanced Medical Sciences and Applied Technologies

Evaluation of the Appropriate Size of Follicles on Success Rate in Patient Undergoing Controlled Ovarian Stimulation and Intrauterine Insemination Cycles

Document Type : Original Articles

Authors
Taravat Fallah Tafti 1
Maryam Yasaei 1
Razieh Dehghani-Firouzabadi 1
Maryam Eftekhar 2
Mohammad Mahdavi-Firoozabadi 3
Soheila Pourmasumi 2
1 Department of Obstetrics and Gynecology, School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
2 Research and Clinical Center for Infertility, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
3 Afshar Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
10.18869/nrip.jamsat.3.2.101
Abstract
Objectives: Intra-Uterine Insemination (IUI) is one of the methods for infertility treatments. The size of the follicles and endometrial thickness are two important factors in pregnancy rate of patients undergoing controlled ovarian stimulation and intrauterine insemination cycles (COH-IUI). The aim of this study was to investigate the success rate of IUI and follicular size and other associated factors in infertile couples. Materials & Methods: The study group was the patients who were undergoing COH-IUI. BMI of all women recorded and ovulation induction was propelled and when there was appropriate endometrial thickness and at least one dominant follicle in trans-vaginal ultrasonography. 36 hours after HCG injection, IUI was performed. Then pregnancy rate between patients who had follicle size fewer than 20 mm and higher than 20 mm was assumed. Results: 159 cases of IUI were performed and pregnancy happened in 22(14.1 %). In non-pregnant group (134 cases), 78 cases had under 20 mm follicles and 47 cases had higher than 20 mm follicles. In pregnant group (22 cases) 10 cases had fewer than 20 mm follicles and 12 cases had higher than 20 mm follicles in the time of HCG injection. Endometrial thickness was 8.01±1.42 mm in patients with follicles more than 20 mm.Conclusion: The success rate in controlled ovarian stimulation and intrauterine insemination cycles closely related to obtaining of optimal size of follicles and endometrial thickness. 
Keywords
Dominant follicle
Pregnancy rate
Intrauterine insemination
Controlled ovarian stimulation
  1. Lessey BA, Young SL. Pathophysiology of infertility in endometriosis. Endometriosis. 2012; 240–54. doi: 10.1002/9781444398519.ch23
  2. Bushnik T, Cook JL, Yuzpe AA, Tough S, Collins J. Estimating the prevalence of infertility in Canada. Human Reproduction. 2012; 27(3):738–46. doi: 10.1093/humrep/der465
  3. Wu MY, Ho HN. Cost and safety of assisted reproductive technologies for human immunodeficiency virus-1 discordant couples. World Journal of Virology. 2015; 4(2):142. doi: 10.5501/wjv.v4.i2.142
  4. Ombelet W, Dhont N, Kruger T. Factors influencing IUI outcome: Semen quality. Intra-Uterine Insemination. 2013; 43–8. doi: 10.1201/b16228-10
  5. Jahaniyan M, Khadem N, Mousavifar N, Tourabizadeh A, Vahidrodsari F, Yousefi Z, et al. The relationship between total motile sperm count and success of intrauterin insemination. Journal of Reproduction & Infertility. 2001; 2(2):48-53.
  6. Dickey RP, Taylor SN, Lu PY, Sartor BM, Rye PH, Pyrzak R. Effect of diagnosis, age, sperm quality, and number of preovulatory follicles on the outcome of multiple cycles of clomiphene citrate-intrauterine insemination. Fertility and Sterility. 2002; 78(5):1088–95. doi: 10.1016/s0015-0282(02)04212-7
  7. Järvelä IY, Tapanainen JS, Martikainen H. Improved pregnancy rate with administration of hCG after Intra-Uterine Insemination: a pilot study. Reproductive Biology and Endocrinology. 2010; 8(1):18. doi: 10.1186/1477-7827-8-18
  8. Kosmas IP, Tatsioni A, Fatemi HM, Kolibianakis EM, Tournaye H, Devroey P. Human chorionic gonadotropin administration vs. luteinizing monitoring for Intra-Uterine Insemination timing, after administration of clomiphene citrate: a meta-analysis. Fertility and Sterility. 2007; 87(3):607–12. doi: 10.1016/j.fertnstert.2006.10.003
  9. Azout A, Bouchard P, Seifer DB, Aussage P, Junca AM, Cohen-Bacrie P. Serum antimüllerian hormone/müllerian-inhibiting substance appears to be a more discriminatory marker of assisted reproductive technology outcome than follicle-stimulating hormone, inhibin B, or estradiol. Fertility and Sterility. 2004; 82(5):1323–9. doi: 10.1016/j.fertnstert.2004.03.061
  10. Palatnik A, Strawn E, Szabo A, Robb P. What is the optimal follicular size before triggering ovulation in Intra-Uterine Insemination cycles with clomiphene citrate or letrozole? An analysis of 988 cycles. Fertility and Sterility. 2012; 97(5):1089–1094.e3. doi: 10.1016/j.fertnstert.2012.02.018
  11. Rosen MP, Shen S, Dobson AT, Rinaudo PF, McCulloch CE, Cedars MI. A quantitative assessment of follicle size on oocyte developmental competence. Fertility and Sterility. 2008; 90(3):684–90. doi: 10.1016/j.fertnstert.2007.02.011
  12. Merviel P, Heraud MH, Grenier N, Lourdel E, Sanguinet P, Copin H. Predictive factors for pregnancy after Intra-Uterine Insemination (IUI): An analysis of 1038 cycles and a review of the literature. Fertility and Sterility. 2010; 93(1):79–88. doi: 10.1016/j.fertnstert.2008.09.058
  13. Knox RV. Recruitment and selection of ovarian follicles for determination of ovulation rate in the pig. Domestic Animal Endocrinology. 2005; 29(2):385-97. doi: 10.1016/j.domaniend.2005.02.025
  14. Randall JM, Templeton A. Transvaginal sonographic assessment of follicular and endometrial growth in spontaneous and clomiphene citrate cycles. Fertility and Sterility. 1991; 56(2):208-12. doi: 10.1016/s0015-0282(16)54473-2
  15. Pursley JR, Silcox RW, Wiltbank MC. Effect of time of artificial insemination on pregnancy rates, calving rates, pregnancy loss, and gender ratio after synchronization of ovulation in lactating dairy cows. Journal of Dairy Science. 1998; 81(8):2139-44. doi: 10.3168/jds.s0022-0302(98)75790-x
  16. Esmailzadeh S, Faramarzi M. Endometrial thickness and pregnancy outcome after Intra-Uterine Insemination. Fertility and Sterility. 2007; 88(2):432–7. doi: 10.1016/j.fertnstert.2006.12.010
  17. Trout S. P-001 A review of 544 clomiphene citrate cycles with hCG-timed Intra-Uterine Insemination (cc/hCG/IUI). Fertility and Sterility. 1997; 68:93. doi: 10.1016/s0015-0282(97)90818-9
  18. Berico G, Vioque J, Ariza N, Lozano JM, Roca M, Llacer J, et al. Analysis of factors influencing pregnancy rates in homologous Intra-Uterine Insemination. Fertility and Sterility. 2004; 81(5):1308-13. doi: 10.1016/j.fertnstert.2003.09.062
  19. Al-Fadhli R, Sylvestre C, Buckett W, Tan SL, Tulandi T. A randomized trial of superovulation with two different doses of letrozole. Fertility and Sterility. 2006; 85(1):161-4. doi: 10.1016/j.fertnstert.2005.07.1283
  20. Roy K, Baruah J, Singla S, Sharma J, Singh N, Jain S, et al. A prospective randomized trial comparing the efficacy of Letrozole and Clomiphene citrate in induction of ovulation in polycystic ovarian syndrome. Journal of Human Reproductive Sciences. 2012; 5(1):20. doi: 10.4103/0974-1208.97789
  21. Koning A, Kuchenbecker W, Groen H, Hoek A, Land J, Khan K, et al. Economic consequences of overweight and obesity in infertility: A framework for evaluating the costs and outcomes of fertility care. Human Reproduction Update. 2010; 16(3):246-54. doi: 10.1093/humupd/dmp053
  22. Wolff EF, Vahidi N, Alford C, Richter K, Widra E. Influences on endometrial development during Intra-Uterine Insemination: clinical experience of 2,929 patients with unexplained infertility. Fertility and Sterility. 2013; 100(1):194-9. doi: 10.1016/j.fertnstert.2013.03.023
  23. Riad ON, Hak AA. Assessment of endometrial receptivity using Doppler ultrasonography in infertile women undergoing Intra-Uterine Insemination. Gynecological Endocrinology. 2013; 30(1):70-3. doi: 10.3109/09513590.2013.859668
  24. Abu Hashim H, El Rakhawy M, Abd Elaal I. Randomized comparison of superovulation with letrozole vs. clomiphene citrate in an IUI program for women with recently surgically treated minimal to mild endometriosis. Acta Obstetricia et Gynecologica Scandinavica. 2012; 91(3):338-45. doi: 10.1111/j.1600-0412.2011.01346.x
  25. Mahey R, Goel T, Gupta M, Kachhawa G, Kriplani A. To evaluate the pregnancy rate after endometrial scratching in couples with unexplained infertility in ovulation induction and IUI cycles. Fertility and Sterility. 2015; 104(3):343. doi: 10.1016/j.fertnstert.2015.07.1068
  26. Eftekhar M, Mohammadian F, Davar R, Pourmasumi S. Comparison of pregnancy outcome after letrozole versus clomiphene treatment for mild ovarian stimulation protocol in poor responders. Iranian Journal of Reproductive Medicine. 2014; 12(11):725-730. PMCID: PMC4330653
  27. Polat M, Yaralı I, Boynukalın K, Yaralı H. In Vitro Fertilization for Endometriosis-Associated Infertility. Women’s Health. 2015; 11(5):633–41. doi: 10.2217/whe.15.50
  28. Harb H, Gallos I, Chu J, Harb M, Coomarasamy A. The effect of endometriosis onin vitrofertilisation outcome: a systematic review and meta-analysis. BJOG: An International Journal of Obstetrics & Gynaecology. 2013; 120(11):1308-20. doi: 10.1111/1471-0528.12366
  29. Sanchez AM, Somigliana E, Vercellini P, Pagliardini L, Candiani M, Vigano P. Endometriosis as a detrimental condition for granulosa cell steroidogenesis and development: From molecular alterations to clinical impact. The Journal of Steroid Biochemistry and Molecular Biology. 2016;155:35–46. doi: 10.1016/j.jsbmb.2015.07.023
  30. Saito H, Seino T, Kaneko T, Nakahara K, Toya M, Kurachi H. Endometriosis and oocyte quality. Gynecologic and Obstetric Investigation. 2002; 53(1):46-51. doi: 10.1159/000049424
  31. Granot I, Gnainsky Y, Dekel N. Endometrial inflammation and effect on implantation improvement and pregnancy outcome. Reproduction. 2012; 144(6):661-8. doi: 10.1530/rep-12-0217
  32. Dickey RP. Evaluation of women with unexplained infertility. Berlin: Springer; 2015.
  33. Dodson WC, Kunselman AR, Legro RS. Association of obesity with treatment outcomes in ovulatory infertile women undergoing superovulation and Intra-Uterine Insemination. Fertility and Sterility. 2006; 86(3):642-6. doi: 10.1016/j.fertnstert.2006.01.040
  34. Wang JX, Warnes G, Davies MJ, Norman RJ. Overweight infertile patients have a higher fecundity than normal-weight women undergoing controlled ovarian hyperstimulation with Intra-Uterine Insemination. Fertility and Sterility. 2004; 81(6):1710-2. doi: 10.1016/j.fertnstert.2003.10.037
  35. Bellver J, Ayllon Y, Ferrando M, Melo M, Goyri E, Pellicer A, et al. Female obesity impairs In Vitro Fertilization outcome without affecting embryo quality. Fertility and Sterility. 2010; 93(2):447-54. doi: 10.1016/j.fertnstert.2008.12.032
  36. Chavarro JE, Ehrlich S, Colaci DS, Wright DL, Toth TL, Petrozza JC, et al. Body mass index and short-term weight change in relation to treatment outcomes in women undergoing assisted reproduction. Fertility and Sterility. 2012; 98(1):109-16. doi: 10.1016/j.fertnstert.2012.04.012
  37. Pandey S, Pandey S, Maheshwari A, Bhattacharya S. The impact of female obesity on the outcome of fertility treatment. Human Reproductive Sciences. 2010; 3(2):62. doi: 10.4103/0974-1208.69332
Journal of Advanced Medical Sciences and Applied Technologies
Volume 3, Issue 2 - Serial Number 2
12
June 2017
Pages 101-108