The choice of treatment for couples diagnosed as having unexplained infertility has been debated. But intrauterine insemination (IUI) is generally performed in the unexplained infertility couples. Despite widespread clinical use of IUI in the
treatment
of infertility, recently to improve the pregnancy rate, the use of controlled ovarian hyperstimulation (COH) in combination with IUI, intrafollicular insemination (IFI) and intratubal insemination (ITI) was greater than the sum of the cycle
fecundity
for IUI without COH.
ITI will give a higher pregnancy rate per cycle than IUI. The presence of spermatozoa in the whole female genital tract and adequate number of spermatozoa will increase the probability for conception.
Intrafollicular insemination (IFI) has recently been reported as a new reproductive technique. The theoretical effect of follicular fluid (FF) is that there are potential protein/steroid-enhancing factors and confining sperm to a controlled in
vivo
pH
and temperature environment. And FF components appear to promote sperm function.
From Jan. 1992 to Aug. 1994, a total of 204 patients during 261 cycles with unexplained infertility were randomized into IUI group (84 cases, 113 cycles), ITI group (78 cases, 100 cycles) and IFI group (42 cases, 48 cycles). Sperm preparation
method for
treatment of IUI, ITI and IFI were different. But the protocols for ovarian stimulation and induction of ovulation were the same in the three groups, GnRH-a modified ultrashort protocol.
Pregnancy rate per cycle were 21/113 (18.6%) in the IUI group, 23/100 (23.0%) in the ITI group and 13/48 (27.0%) in the IFI group, IFI and ITI (27.0%, 23.0%) have shown a higher pregnancy rate per cycle than IUI (18.6%).
This study indicates that in the treatment of couples with unexplained infertility, IFI and ITI are more successful than IUI.
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