Fallopian Tube Insemination as Outpatient Procedure

Objective: To evaluate the efficacy of fallopian tube insemination in controlled ovarian hyperstimulation (COH) cycles. Design: Prospective randomized study. Setting: Ovulation induction program of according to protocols of controlled ovarian stimulation. At Zagazig University Hospitals. Zagazig University Hospital, Obstetrics and Gynecology Department, from Period between November 2011 to November 2012. Population: We studied 100 infertile women aged 18 to 40 years undergoing 100 cycles of COH (not include repeated cycle). Methods: The inclusion criteria were; oligoatenospermia, patent at least one fallopian tube, one or more follicle with diameter between 18-24mm during foliclmetry. The exclusion criteria were; patient age more than 40 years, bilateral tubal block. All patient subjected to history taking, general examination, routine laboratory evaluation, ultrasound evaluation and hysterosalpingography. Controlled ovarian hyperstimulation was achieved using of ovarian stimulation protocols: Clomiphene citrate (CC) and hMG (n=50) or hMG alone (n=40) or recombinant FSH (n=10). After computerized assisted semen analysis CASA and HSG, foliculometry was done to all patients with detection of follicle number, diameter of follicles ,endometrial thickness. Thirty-six hours after hCG administration, patients were subjected to fallopian tube insemination. Fallopian tube insemination was performed using a 4mL of sperm suspension after sperm preparation. The sperm preparation and IFI was done as outpatient procedure. Passive straightening of the uterus was used in all patients. Main Outcome Measures: Validity (efficacy = feasibility) of the fallopian tube insemination method, chemical pregnancy, clinical pregnancy, incidence of complications (multiple pregnancies and ovarian hyperstimulation syndrome [OHSS]). Results: The intra-fallopian tube insemination (I.F.I.) well tolerated by patients. The observed 25 clinical pregnancies (25%) of which 20 were ongoing (20%). The presence of more than one sac pregnancies was 10 (10%). No case of moderate or severe OHSS was observed in this study. Conclusion: Results of this study indicate that the simple outpatient less costy method for intra-fallopian insemination is not only simple and reliable but also may lead to clinical pregnancy twice as high as standard IUI in COH cycles.