Abstract
Objectives
To evaluate the efficacy of in vitro fertilization (IVF) and intra-uterine insemination (IUI) in couples with unexplained and mild male factor infertility.
Methods
One hundred fifty couples were allocated to treatment with IVF and IUI, both following the same protocol (clomiphene citrate and follicle stimulating hormone (FSH) injection) depending upon their hormonal response. The mild male factor patients were included in the study because we observed that their rate of failed fertilization was not different from those in couples with unexplained infertility. They had ovulatory cycles confirmed by recent ovulatory mid luteal phase progesterone measurement and bilateral tubal patency, which was confirmed by laparoscopy or hysterosalpingography. Men with unexplained infertility had semen analysis with a sperm concentration ≥25×106/ml, motility (grdel + 2) ≥40% and normal forms ≥25%. Men with mild male factor infertility had semen analysis where only one of the above parameters was below the normal range.
Results
Among the 150 couples, 75 were treated with IVF and 75 were treated with IUI. The mean age of women allocated to IVF was 32.9 years compared to 33.2 years for the IUI treatment group. Cycle day 2 basal plasma estradiol, LH and FSH concentrations were also not different (geometric means; Estradiol 244 and 245 pmol/1, LH 4.9 and 5.3 IU/1, FSH 7.5 and 7.7 IU/1 in the IVF and IUI treatment groups, respectively).
Conclusion
IUI is the first choice of treatment for unexplained and mild male factor infertility with a lower cost and the equal efficacy as IVF. Treatment delivered within the context of a specialized IVF center will be more efficient and safer because of the potential to salvage over-responding cycles by conversion to IVF.
Key words: unexplained infertility, male factor, IVF, IUI
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