2010년 유럽불임학회(ESHRE) P-524 Relationship between time interval of hCG administration and IUI outcome. (인공수정 시술 시 hCG 주사 시간과 시술 시간의 간격이 임신율에 영향을 준다.)

J.H. Lee, S.G. Kim, E.M. Cha, I.H. Park and K.H. Lee
Mamapapa&baby Hospital, Infertility Lab., Ulsan, Korea South

INTRODUCTION

 Intrauterine insemination (IUI) has been used for many years as a treatment method for infertile couples.
IUI was usually ovarian stimulation with clomiphene citrate (CC) or/and hMG before ovulation with human chorionic gonadotrophin (hCG) administration. And follicular repute usually occurs 36-48h after hCG administration. HCG has also been routinely used in IUI cycles to promote the final maturation and ovulation of follicles. HCG is the most widely used drug for inducing final follicular maturation and ovulation after ovarian stimulation.
Many different time intervals have been suggested for IUI after hCG injection for the management of infertility. Intervals between hCG administration and IUI have been recommended to be anywhere between 12 and 60 hours. Irrespective of the apparent efficacy of superovulation IUI, it has been difficult to decide on the best timing for IUI after hCG administration. But the optional time interval from administration of hCG to IUI for the best pregnancy rates has not been determined. The objective of this study is to compare the pregnancy rates resulting from interval time between hCG administration and IUI.

MATERIALS AND METHODS

In a retrospective study, the relationship between interval hCG - IUI time and pregnancy has been studied in 209 IUI cycles performed between June 2009 and December 2009. The patient was divided by two groups in pregnancy: group 1 pregnancy (n=37) and group 2 nonpregnancy (n=172) cycles. We examined the question of whether IUI is best timed by hCG administration, the patient was divided into three subgroups:
Group A - IUI performed <24hours after hCG administration (n=50).
Group B - IUI performed 24< and >30 hours after hCG administration (n=128).
Group C - IUI performed >30hours after hCG administration (n=31).

RESULTS

The mean age of the female patient was 33.4 years. The overall pregnancy rate was 15.3% per cycles. Then two groups (pregnancy vs. nonpregnancy) were similar with interval hCG-IUI time. (25 vs. 26h). We divided into three groups for analysis optional hCG-IUI interval time. Pregnancy outcomes including clinical pregnancy rates (Group A: 12.0 %, Group B: 22.6%, Group C: 6.4%) and implantation rates (7.8%, 18.4%, 6.5%) were increased for group B than for group A and C.

CONCLUSION

Our results differ from those of others who recommended that IUI performs 36-38h after hCG administration. Motility of inseminated sperm decrease with time it affects adversely on fertility ability. Pregnancy rate was low when sperms inseminated after 30h because the ovulation may occur before sperm obtains fertility ability. Further study needs a large population to estimate best optimal time of hCG administration.