The utility of detecting ovulation to predict success in ovulation induction and intrauterine insemination cycles — a prospective observational study
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Abstract
Objectives: The success of ovulation induction-intrauterine insemination (OI-IUI) procedures may be limited by the absence of ovulation detection. The aim of this study was to evaluate the empirical use of ultrasonography and luteal phase progesterone (P4) as ovulation indicators and determine its effect on pregnancy outcome in OI-IUI cycles.
Material and methods: This prospective observational study, which was performed in a university setting, included 107 women with unexplained infertility. Following OI, IUI was performed 36 hours after human chorionic gonadotropin (hCG). P4 was measured 72–96 hours after hCG. At the same time, the appearance of ovaries and signs indicative of ovulation, which are decreased follicle dimensions, irregularity of follicular walls, and the presence of free fluid in the Douglas pouch, were noted.
Results: In 58 patients (54.2%), ovulation was detected at the P4 level of > 10 ng/mL. Eighty-nine patients had ultrasound images suggestive of ovulation. However, only 50 of these were confirmed ovulation as indicated using P4. Implantation was observed in a total of 13 patients (12.1%). All patients were in the ovulation detected group with P4 > 10 ng/mL (AUC: 0.750; p = 0.004). P4 of > 21.5 ng/mL detected successful ovulation and was strongly associated with implantation with 77% sensitivity and 61% specificity (OR: 9.9; 95% CI: 2.4–41.2). Body mass index (BMI) > 23.9 kg/m2 was a reliable anovulation indicator as a secondary outcome (AUC: 0.696; p = 0.02).
Conclusions: In 45.8% of the patients, ovulation did not occur even with OI treatment. The association of progesterone measurement and ovarian ultrasound scanning between 72 and 96 hours after hCG treatment can be used to detect ovulation. In doing so, we can find the optimal treatment for patients with infertility in their next cycle.
Keywords: ovulationovulation inductionprogesteroneimplantationintrauterine insemination
References
- Hansen KR, Eisenberg E, Baker V, et al. NICHD Reproductive Medicine Network. Midluteal progesterone: a marker of treatment outcomes in couples with unexplained infertility. J Clin Endocrinol Metab. 2018; 103(7): 2743–2751.
- Goverde AJ, McDonnell J, Vermeiden JP, et al. Intrauterine insemination or in-vitro fertilisation in idiopathic subfertility and male subfertility: a randomised trial and cost-effectiveness analysis. Lancet. 2000; 355(9197): 13–18.
- Thomas S, Sebastian T, Karthikeyan M, et al. Effectiveness of spontaneous ovulation as monitored by urinary luteinising hormone versus induced ovulation by administration of human chorionic gonadotrophin in couples undergoing gonadotrophin-stimulated intrauterine insemination: a randomised controlled trial. BJOG. 2019; 126(Suppl 4): 58–65.
- Qublan H, Amarin Z, Nawasreh M, et al. Luteinized unruptured follicle syndrome: incidence and recurrence rate in infertile women with unexplained infertility undergoing intrauterine insemination. Hum Reprod. 2006; 21(8): 2110–2113.
- Cantineau AEP, Janssen MJ, Cohlen BJ, et al. Synchronised approach for intrauterine insemination in subfertile couples. Cochrane Database Syst Rev. 2014(12): CD006942.
- Ecochard R, Marret H, Rabilloud M, et al. Sensitivity and specificity of ultrasound indices of ovulation in spontaneous cycles. Eur J Obstet Gynecol Reprod Biol. 2000; 91(1): 59–64.
- Large MJ, DeMayo FJ. The regulation of embryo implantation and endometrial decidualization by progesterone receptor signaling. Mol Cell Endocrinol. 2012; 358(2): 155–165.
- Cooper TG, Noonan E, von Eckardstein S, et al. World Health Organization reference values for human semen characteristics. Hum Reprod Update. 2010; 16(3): 231–245.
- Cédrin-Durnerin I, Isnard T, Mahdjoub S, et al. Serum progesterone concentration and live birth rate in frozen-thawed embryo transfers with hormonally prepared endometrium. Reprod Biomed Online. 2019; 38(3): 472–480.
- Perkins SL, Al-Ramahi M, Claman P. Comparison of serum progesterone as an indicator of pregnancy nonviability in spontaneously pregnant emergency room and infertility clinic patient populations. Fertil Steril. 2000; 73(3): 499–504.
- Arce JC, Balen A, Platteau P, et al. Mid-luteal progesterone concentrations are associated with live birth rates during ovulation induction. Reprod Biomed Online. 2011; 22(5): 449–456.
- Costello MF, Emerson S, Lukic J, et al. Predictive value of mid luteal progesterone concentration before luteal support in controlled ovarian hyperstimulation with intrauterine insemination. Aust N Z J Obstet Gynaecol. 2004; 44(1): 51–56.
- Yildirim G, Turkgeldi LS, Koroglu N. Predictive factors for pregnancy outcome following controlled ovarian stimulation and intrauterine insemination. J Pak Med Assoc. 2017; 67(3): 422–427.
- Farquhar C, Liu E, Armstrong S, et al. Intrauterine insemination with ovarian stimulation versus expectant management for unexplained infertility (TUI): a pragmatic, open-label, randomised, controlled, two-centre trial. Lancet. 2018; 391(10119): 441–450.
- Jungheim ES, Lanzendorf SE, Odem RR, et al. Morbid obesity is associated with lower clinical pregnancy rates after in vitro fertilization in women with polycystic ovary syndrome. Fertil Steril. 2009; 92(1): 256–261.
- Fedorcsák P, Dale PO, Storeng R, et al. Impact of overweight and underweight on assisted reproduction treatment. Hum Reprod. 2004; 19(11): 2523–2528.
