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Federación Mexicana de Ginecología y Obstetricia, A.C.

2008, Número 01

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Ginecol Obstet Mex 2008; 76 (01)


Inseminación intrauterina versus coito programado en ciclos de hiperestimulación ovárica controlada

Barros DJC, Martínez BE, Moreno AC, Godines EMS, Manzur NF, Sánchez SV, Barroso VG

Idioma: Español
Referencias bibliográficas: 36
Paginas: 18-31
Archivo PDF: 198.14 Kb.


RESUMEN

Antecedentes: las técnicas de reproducción asistida se utilizan cada vez con mayor frecuencia en el tratamiento de parejas con diagnóstico de infertilidad.
Objetivo: analizar el valor de la inseminación intrauterina en pacientes a quienes se realiza hiperestimulación ovárica controlada.
Material y métodos: estudio analítico, comparativo, retrospectivo y longitudinal de casos y controles. Se analizaron los ciclos de inseminación intrauterina (grupo I) y de coito programado (grupo II) de pacientes a quienes se efectuó hiperestimulación ovárica controlada, del 1 enero del 2004 al 31 diciembre del 2006. Se incluyeron pacientes infértiles entre 24 y 42 años (grupo I) y entre 23 y 36 años de edad (grupo II). Se analizaron: edad, tipo, causa y tiempo de infertilidad, densidad y movilidad espermática poscapacitación, así como espermatobioscopia directa para coito programado; número de folículos totales y maduros, grosor endometrial, tipo y dosis de gonadotropina y día de inseminación para el grupo I o día de inicio del coito para el grupo II. Los resultados se analizaron con los programas STATA 7.0 y SPSS 12.0.
Resultados: se analizaron 873 ciclos en 539 pacientes del grupo I y 246 ciclos en 138 pacientes del grupo II. La tasa de embarazo por ciclo fue de 13.1% (inseminación intrauterina) y de 5.2% (coito programado, p›0.05). La edad promedio para inseminación intrauterina y coito programado fue de 32.9 ± 3.5 y de 31.82 ± 2.7 años, respectivamente. Hubo diferencia significativa sólo en la densidad espermática entre ambos grupos.
Conclusiones: la inseminación intrauterina no parece tener ventaja sobre el coito programado en las tasas de embarazo de pacientes que han recibido hiperestimulación ovárica controlada.


REFERENCIAS (EN ESTE ARTÍCULO)

  1. Allen NC, Herbert CM, Mason WS, Rogers BJ, Diamond MP, Wentz AC. Intrauterine insemination a critical review. Fertil Steril 1985;44:569-80.

  2. Cohlen BJ, te Velde ER, van Kooij RJ, Looman CW, Habbema JD. Controlled ovarian hyperstimulation and intrauterine insemination for treating male sub-fertility: a controlled study. Hum Reprod 1993;13:1553-8.

  3. Hughes EG. The effectiveness of ovulation induction and intrauterine insemination in the treatment of persistent infertility: a meta-analysis. Hum Reprod 1997;12:1865-72.

  4. Mitwally M, Abdel-Razeq S, Casper R. Human chorionic gonadotropin administration is associated with high pregnancy rates during ovarian stimulation and timed intercourse of intrauterine insemination. Reprod Biol EndocrinoI 2004;2:1-8.

  5. Dickey RP, Olar TT, Taylor SN, Curole ON, et al. Relationship of follicule number, serum estradiol, and other factors to birth rate and multiparity in human menopausal gonadotropin induced intrauterine insemination cycles. Fertil Steril 1991;56:89-92.

  6. Burr RW, Sieberg R, Flaherty SP, Wang XJ, Mathews CD. The influence of sperm morphology and the number of motile sperm inseminated on the outcome of intrauterine insemination combined with mild ovarian stimulation. Fertil Steril 1996;65:127-32.

  7. Berger T, Marrs RP, Moyer DL. Comparison of techniques for selection of motile spermatozoa. Fertil Steril 1985;43:268-73.

  8. Ransom MX, Bohrer M, Kemmann I, Blotner MB, Carsan BE. Does of intrauterine insemination improve pregnancy rates significantly during superovulation cycles? Fertil Steril 1994;61:303-7.

  9. Khalifa Y, Redgment CJ, Tsirigotis M, Grudzinskas JG, Craft IL. The value of single versus repeated insemination in intrauterine donor insemination cycles. Hum Reprod 1995;10:153-4.

  10. Collins JA, Crosignani PG. Unexplained infertility: a review of diagnosis, prognosis, treatment efficacy and management. Int J Gynaecol Obstet 1992;39:267-75.

  11. Dodson WC, Haney AF. Controlled ovarian hyperstimulation and intrauterine insemination for treatment of infertility. Fertil Steril 1991;55:457-67.

  12. Testart J, Frydman R. Minimum time lapse between luteinizing hormone surge of human chorionic gonadotropin administration and follicular rupture. Fertil Steril 1982; 37:50-53.

  13. Zeyneloglu HB, Arici A, Olive DL, Duleba AJ. Comparison of intrauterine insemination with timed intercourse in superovulated cycles with gonadotropins: a meta-analysis. Fertil Steril 1998;69:486-91.

  14. Martinez AR, Bernardus RE, Voorhorst FJ, Vermeiden JP, Schoemaker J. Intrauterine insemination does and clomiphene citrate does not improve fecundity in couples with infertility due to male or idiopathic factors: a prospective, randomized, controlled study. Fertil Steril 1990;53:847-53.

  15. Karlstrom PO, Bergh T, Lundkvist O. A prospective randomized trial of artificial insemination versus intercourse in cycles stimulated with human menopausal gonadotropin or clomiphene citrate. Fertil Steril 1993;59:554-9.

  16. Melis GB, Paoletti AM, Strigini F, Fabris FM, Canale O, Fioretti P. Pharmacologic induction of multiple follicular development improves the success rate of artificial insemination with husband’s semen in couples with male related or unexplained infertility. Fertil Steril 1987;47:441-5.

  17. Dickey RP, Alar TT, Taylor SN, Curole ON, Rye PH. Relationship of follicle number and other factors to fecundability and multiple pregnancy in clomiphene citrate-induced intrauterine insemination cycles. Fertil Steril 1992;57:613-9.

  18. Serbal PF, Katz M, Little V, Woronowski H. Unexplained infertility the value of pergonal superovulation combined with intrauterine insemination. Fertil Steril 1988;49:602-6.

  19. Kemmann E, Bohrer M, Shelden R, Fiasconaro G, Beardsley L. Active ovulation management increases the monthly probability of pregnancy occurrence in ovulatory women who receive intrauterine insemination. Fertil Steril 1987;48:916-20.

  20. Navot O, Bergh PA, William MA. Poor oocyte quality rather than implantation failure as a cause of age related decline in female fertility. Lancet 1991;337;1375-7.

  21. Campana A, Sakkas O, Stalberg A, Bianchi PG, et al. Intrauterine insemination evaluation of the results according to the woman’s age, sperm quality, total sperm count per insemination and life table analysis. Hum Reprod 1996;11:732-6.

  22. Mathieu C, Ecochard R, Bied V. Cumulative conception rate following intrauterine artificial insemination with husband’s age. Hum Reprod 1995;10:1090-7.

  23. Barros JC, Rojas JC, Molina AC, Villalobos S, y col. Factores pronósticos de embarazo en inseminación intrauterina. Ginecol Obstet Mex 2006;74:611-25.

  24. Kossoy LR, Hill GA, Parker RA. Luteinizing hormone and ovulation timing in a therapeutic donor insemination program using frozen semen. Am J Obstet Gynecol 1988;158:980-9.

  25. Khalil RM, Emil RP, Karin E, Broch LS, et al. Homologous intrauterine insemination. An evaluation of prognostic factors based on a review of 2473 cycles. Scand Soc Obstet Gynecol 1998;80:74-81.

  26. Martinez AR, Bernardus RE, Voorhorst FJ, Vermeiden JPW, Schoemaker J. Pregnancy rates after timed intercourse or intrauterine insemination after human menopausal gonadotropin stimulation of normal ovulatory cycles: a controlled study. Fertil Steril 1991;55:258-65.

  27. Martinez AR, Bernardus RE, Vermeiden JPW. Factors affecting pregnancy results after intrauterine insemination. Hum Reprod 1988:35-42.

  28. Urry RL, Middleton RG, McGavin S. A simple and effective technique for increasing pregnancy rates in couples with retrograde ejaculation. Fertil Steril 1986;46:1124-8.

  29. Cruz RI, Kemmann E, Brandeis BT. A prospective study of intrauterine insemination of processed sperm from men with oligoasthenospermia in superovulated women. Fertil Steril 1986;46:673-8.

  30. Check JH, Adelson H, Lurie O, Jamison T. Effect of the short follicular phase on subsequent conception. Gynecol Obstet Invest 1992;34:180-3.

  31. Manual de laboratorio de la OMS para el examen del semen humano y de la interacción entre el semen y el moco cervical. 4a ed. México: OMS-Médica Panamericana, 2002.

  32. Biljan MM, Mahutte NG, Tulandi T, Tan SL. Prospective randomized double-blind trial of the correlation between time of administration and antiestrogenic effects of clomiphene citrate on reproductive end organs. Fertil Steril 1999;71:633-8.

  33. Stanger JD, Yovich JL. Reduced in vitro fetilization of human oocytes from patients with raised basal luteinizing hormone levels during the follicular phase. Br J Obstet Gynaecol 1985;92:385-93.

  34. Melis GB, Paoletti AM, Ajossa S, Guerriero S. Ovulation induction with gonadotropins as sole treatment in infertile couples with open tubes: a randomized prospective comparison between intrauterine insemination and timed vaginal intercourse. Fertil Steril 1995;64:1088-93.

  35. Zikopoulos K, West CP, Thong PW, Kaeser EM, et al. Homologous intra-uterine insemination has no advantage over timed natural intercourse when used in combination with ovulation induction for the treatment of unexplained infertility. Hum Reprod 1993;8:563-7.

  36. Helmerhorst FM, Van Vliet HAAM, Gornas T, Finken MJJ, Grimes DA. Intrauterine insemination vs timed intercourse for cervical hostility in subfertil couples (review). Cochrane data base of systematic reviews 2005; Issue 4. Art. No.: CD002809. 001: 10.1002/14651858. CD002909.pub2.




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