A New Rapid and Effective Method for Treatment of Unexplained Infertility
A New Rapid and Effective Method for Treatment of Unexplained Infertility
Background: Artificial insemination (intrauterine insemination by husband or artificial insemination by husband) is often tried as first treatment for couples with unexplained infertility. Pertubation has previously proved to increase the chance of achieving pregnancy for these couples. The effect of pertubation on fertility can be mechanical as well as anti-inflammatory by using a substance that inhibits phagocytosis of the spermatozoa. The objective of the study was to investigate the effect on pregnancy rate of pre-ovulatory pertubation with low-dose lignocaine during clomiphene citrate and insemination cycles for couples with unexplained infertility.
Methods: In a prospective, open study, the patients were randomized, the day before ovulation, during a clomiphene citrate stimulated cycle to either pertubation with low-dose local anaesthetic or no pertubation before insemination.
Results: A total of 130 cycles were studied, 67 of which were randomized to pre-ovulatory pertubation and 63 to no pertubation treatment. There were 14.9% (n = 10) clinical pregnancies in the pertubated group compared with 3.2% (n = 2) in the group without pre-ovulatory pertubation (P < 0.05).
Conclusions: The pertubation treatment significantly enhanced the clinical pregnancy rate and was well tolerated. No complications were noted. The combined treatment of clomiphene citrate, pertubation and insemination can be used as a cost-effective, first-line treatment for couples with unexplained infertility.
Investigation of infertility is initiated after 1 year of attempts to achieve spontaneous pregnancy. During such an investigation, blood samples are taken concerning the basal hormone levels and the ovulatory function in the female. The male partner primarily only has a sperm count carried out. For women with dysmenorrhoea, a laparoscopy can be a part of the infertility investigation to evaluate any presence of endometriotic implants. For most infertile women in Sweden, Hysterosalpingo-Contrast-Sonography (HyCoSy) has gradually replaced the laparoscopy and peroperative tubal patency test. The consequence is that an unknown number of couples are diagnosed as having unexplained infertility, although endometriosis might be the cause. The explanation of the reduced fertility caused by minimal peritoneal endometriosis is still not clear (Hull, 1992; Halis and Arici, 2004). Treatments with GnRH gave initial hope but have only reduced pain and not improved fertility (Olive, 2004). There are several reports on intraperitoneal changes with increased amounts of leukocytes having an enhanced capacity of phagocytosing spermatozoa and thereby reducing fertility (Haney et al., 1983).
Usually, artificial insemination (intrauterine insemination—husband, artificial insemination—husband) is tried as first treatment for couples with unexplained infertility (Verhulst et al., 2006). Thus, insemination during three to four cycles can be offered while the couples are on the waiting list for IVF. IVF is usually offered as a second treatment option, but the most effective way of obtaining pregnancy for couples with unexplained infertility has not yet been clearly demonstrated (Guzick et al., 1998; Pandian et al., 2005). There are recent studies indicating that endometriosis has a negative impact on the outcome of IVF for this patient group (Halis and Arici, 2004). Ovulation stimulation and insemination have also shown poorer results for endometriosis patients than for couples with unexplained infertility (De Hondt et al., 2005). Compared with untreated couples in natural cycles, ovulation stimulation alone has not significantly improved fertility (Guzick et al., 1998).
Tubal flushing or pertubation has previously proved to be one way of increasing the chance of achieving pregnancy for couples with unexplained infertility and early stages of endometriosis (Johnson et al., 2005). Pertubation treatment can be administered in an outpatient clinic and represents a less invasive treatment alternative (Edelstam et al., 2001). The effect of pertubation on fertility can be mechanical as well as immunological, e.g. inhibited phagocytosis of spermatozoa (Edelstam et al., 1998) and by affecting levels of peritoneal factors such as cytokines (Oak et al., 1985; Agic et al., 2006). HyCoSy is carried out in most infertility investigations and the adjuvant effect of this examination on achieving spontaneous pregnancy is clinically well documented (Johnson et al., 2005).
The present study was carried out to investigate the effect on pregnancy rate of pertubation with lignocaine in a balanced salt solution the day before ovulation. Lignocaine was used with the purpose of further evaluating the inhibitory effect on sperm phagocytosis in vivo and the fertility adjuvant effect previously found.
In this randomized, prospective, open study, the patients were randomized to either pertubation with low-dose lignocaine or no pertubation before insemination.
Abstract and Introduction
Abstract
Background: Artificial insemination (intrauterine insemination by husband or artificial insemination by husband) is often tried as first treatment for couples with unexplained infertility. Pertubation has previously proved to increase the chance of achieving pregnancy for these couples. The effect of pertubation on fertility can be mechanical as well as anti-inflammatory by using a substance that inhibits phagocytosis of the spermatozoa. The objective of the study was to investigate the effect on pregnancy rate of pre-ovulatory pertubation with low-dose lignocaine during clomiphene citrate and insemination cycles for couples with unexplained infertility.
Methods: In a prospective, open study, the patients were randomized, the day before ovulation, during a clomiphene citrate stimulated cycle to either pertubation with low-dose local anaesthetic or no pertubation before insemination.
Results: A total of 130 cycles were studied, 67 of which were randomized to pre-ovulatory pertubation and 63 to no pertubation treatment. There were 14.9% (n = 10) clinical pregnancies in the pertubated group compared with 3.2% (n = 2) in the group without pre-ovulatory pertubation (P < 0.05).
Conclusions: The pertubation treatment significantly enhanced the clinical pregnancy rate and was well tolerated. No complications were noted. The combined treatment of clomiphene citrate, pertubation and insemination can be used as a cost-effective, first-line treatment for couples with unexplained infertility.
Introduction
Investigation of infertility is initiated after 1 year of attempts to achieve spontaneous pregnancy. During such an investigation, blood samples are taken concerning the basal hormone levels and the ovulatory function in the female. The male partner primarily only has a sperm count carried out. For women with dysmenorrhoea, a laparoscopy can be a part of the infertility investigation to evaluate any presence of endometriotic implants. For most infertile women in Sweden, Hysterosalpingo-Contrast-Sonography (HyCoSy) has gradually replaced the laparoscopy and peroperative tubal patency test. The consequence is that an unknown number of couples are diagnosed as having unexplained infertility, although endometriosis might be the cause. The explanation of the reduced fertility caused by minimal peritoneal endometriosis is still not clear (Hull, 1992; Halis and Arici, 2004). Treatments with GnRH gave initial hope but have only reduced pain and not improved fertility (Olive, 2004). There are several reports on intraperitoneal changes with increased amounts of leukocytes having an enhanced capacity of phagocytosing spermatozoa and thereby reducing fertility (Haney et al., 1983).
Usually, artificial insemination (intrauterine insemination—husband, artificial insemination—husband) is tried as first treatment for couples with unexplained infertility (Verhulst et al., 2006). Thus, insemination during three to four cycles can be offered while the couples are on the waiting list for IVF. IVF is usually offered as a second treatment option, but the most effective way of obtaining pregnancy for couples with unexplained infertility has not yet been clearly demonstrated (Guzick et al., 1998; Pandian et al., 2005). There are recent studies indicating that endometriosis has a negative impact on the outcome of IVF for this patient group (Halis and Arici, 2004). Ovulation stimulation and insemination have also shown poorer results for endometriosis patients than for couples with unexplained infertility (De Hondt et al., 2005). Compared with untreated couples in natural cycles, ovulation stimulation alone has not significantly improved fertility (Guzick et al., 1998).
Tubal flushing or pertubation has previously proved to be one way of increasing the chance of achieving pregnancy for couples with unexplained infertility and early stages of endometriosis (Johnson et al., 2005). Pertubation treatment can be administered in an outpatient clinic and represents a less invasive treatment alternative (Edelstam et al., 2001). The effect of pertubation on fertility can be mechanical as well as immunological, e.g. inhibited phagocytosis of spermatozoa (Edelstam et al., 1998) and by affecting levels of peritoneal factors such as cytokines (Oak et al., 1985; Agic et al., 2006). HyCoSy is carried out in most infertility investigations and the adjuvant effect of this examination on achieving spontaneous pregnancy is clinically well documented (Johnson et al., 2005).
The present study was carried out to investigate the effect on pregnancy rate of pertubation with lignocaine in a balanced salt solution the day before ovulation. Lignocaine was used with the purpose of further evaluating the inhibitory effect on sperm phagocytosis in vivo and the fertility adjuvant effect previously found.
In this randomized, prospective, open study, the patients were randomized to either pertubation with low-dose lignocaine or no pertubation before insemination.
