Intrauterine Insemination and Luteal Support Therapy Outcomes in Unexplained Infertility, Mild and Marked Luteal Defective Infertile Women

Abstract

Back ground: Inadequate secretory transformation of the endometrium resulting from deficient ovarian progesterone secretion is a cause of infertility and recurrent abortion
in luteal phase defects (LPD) women. LPD are diagnosed in 20% of infertile patients and 60% of patients with recurrent abortion and 50% of anovulatory women.
Aim : The objective of the present study was to compare pregnancy outcome following sperm penetration assay (SPA), intrauterine insemination (IUI) and luteal support
therapy (LST) in infertile patients with unexplained infertility (UI) mild and marked LPD.
Materials and Methods: Men with normal semen analyses and positive sperm penetration assay scores were included in this Study while those men with abnormal
semen and negative SPA score were admitted to 1C SI program in another study. The patients were divided into three groups: first group n= 42 with UI without LPD, second
group n= 60 with mild LPD and third group n= 58 with marked LPD. Progesterone (P) concentration was assayed on cycle day 21 and patients showing P concentration of <
3.50 ng/ml were considered to have marked LPD and those with <10 ng/ml were considered to have mild LPD. All patients received clomiphene citrate, human
menopausal gonadotropin and human chorionic gonadotropin (HCG) for ovulation induction. The patients received 1500 IU of HCG on cycle day 14, 17, 20 and 23 after
IUI. Beta-HCG test was performed two weeks after IUI and when the test was positive, the patients continued to receive the HCG treatment every three days for a period of
three months.
Results: There were no significant differences in the SPA and semen analysis parameters between the groups. The Progesterone concentration was significantly
different among the groups (18.4, 8.9, and 2.4 in the first and second and third groups (P<0.05) respectively on cycle day 21 prior to ovulation induction. Two weeks
following IUI, the Progesterone concentration in the marked LPD group was significantly lower compared to mild and unexplained infertility groups (13.5 versus
20.3, and 22.8 ng/ml, P<0.05, respectively). The pregnancy rate per cycle was 35.7% in the unexplained infertility group and 40% in the mild LPD group and 31% in the
marked LPD group (P>0.05).
Conclusion: In conclusion, the use of IUI and luteal support therapy in the mild, marked LPD infertile patients and unexplained infertility resulted in similar pregnancy
rates.