International Journal of Infertility & Fetal Medicine

Register      Login

VOLUME 10 , ISSUE 1 ( January-April, 2019 ) > List of Articles


To Compare the Exogenous Human Chorionic Gonadotropin Trigger with Endogenous Leutinizing Hormone Surge in Ultrasound Monitored Cycles for Timing of Intrauterine Insemination in Women with Unexplained Infertility

Anuradha Singh, Gyaneshowari Leishram

Keywords : Infertility, Pregnancy, Ultrasonography

Citation Information : Singh A, Leishram G. To Compare the Exogenous Human Chorionic Gonadotropin Trigger with Endogenous Leutinizing Hormone Surge in Ultrasound Monitored Cycles for Timing of Intrauterine Insemination in Women with Unexplained Infertility. Int J Infertil Fetal Med 2019; 10 (1):8-11.

DOI: 10.5005/jp-journals-10016-1178

License: CC BY-NC 4.0

Published Online: 01-04-2015

Copyright Statement:  Copyright © 2019; The Author(s).


Aim: To compare rates of follicular rupture after human chorionic gonadotropin (hCG) trigger with after spontaneous leutinizing hormone (LH) surge in women undergoing controlled ovarian stimulation (COS) and intrauterine insemination (IUI). To observe any findings suggestive of premature LH surge in hCG triggered cycles and compare the pregnancy rates in the two groups. Materials and methods: A total of thirty-three women with unexplained infertility were enrolled. Women were subjected to COS with injection follicle stimulating hormone (FSH) 75IU I/M for 5 days. A total of 100 cycles were studied. The cycles were divided in to two groups. In group I, ultrasound monitoring was done from day 8 till follicle size of 18 mm followed by trigger with injection hCG 5,000 IU followed by IUI after 36–48 hours of injection hCG. Group II cycles were followed with ultrasound till follicle size 14 mm and urinary LH surge test was done till it turned positive. Ultrasound was done after 24 hours of positive test and then IUI. The two groups were compared about the proportion of cycles with documented rupture of follicle. The pregnancy rates and presence of features suggestive of premature luteinization in hCG triggered cycles were studied. Results: The mean time of follicular rupture was 43 ± 8.32 hours in group I from hCG trigger and 27.77 ± 8.69 hours in group II from positive LH surge. The difference between number of cycles with documented follicular rupture and mean day of IUI was not significant in the two groups (95.35% vs 85.58%). The pregnancy rate was higher in group II than group I (11.6% vs 7.3%) but the difference was not significant statistically. Conclusion: Adequately powered studies are required to support the preference of endogenous LH surge to exogenous LH surge (hCG trigger) for timing of IUI. Clinical significance: To compare exogenous LH surge (hCG trigger) with endogenous LH surge to for timing of IUI in unexplained infertility.

PDF Share
  1. Aubuchom M, Burney RO, Schust DJ, et al. Infertility and assisted reproductive technique. In: Berek JS, ed. Berek and Novak's Gynaecology, 15th ed., New Delhi: Wolters Klumer India Pvt. Ltd; 2011. pp. 1133–1189.
  2. Kyrou D, Kolibianakis EM, Fatemi HM, et al. Spontaneous triggering of ovulation versus HCG administration in patients undergoing IUI: a prospective randomized study. Reprod Biomed Online 2012;25(3):278–283. DOI: 10.1016/j.rbmo.2012.05.005.
  3. Taerk E, Hughes E, Greenberg C, et al. Controlled ovarian hyperstimulation with intrauterine insemination is more successful after r-hCG administration than spontaneous LH surge. J Reprod Infertil 2017;18(3):316–322.
  4. Fuh KW, Wang X, Tai A, et al. Intrauterine insemination: effect of the temporal relationship between the luteinizing hormone surge, human chorionic gonadotrophin administration and insemination on pregnancy rates. Hum Reprod 1997;12(10):2162–2166. DOI: 10.1093/humrep/12.10.2162.
  5. Martinez AR, Bernardus RE, Vermeiden JP, et al. Time schedules of intrauterine insemination after urinary luteinizing hormone surge detection and pregnancy results. Gynecol Endocrinol 1994;8(1):1–5. DOI: 10.3109/09513599409028450.
  6. Khattab AF, Musafa FA, Taylor PJ. The use of urine LH detection kits to time IUI with donor sperm. Hum Reprod 2005;20(9):2542–2545. DOI: 10.1093/humrep/dei098.
  7. Cantineau AE, Janssen MJ, Cohlen BJ, et al. Synchronised approach for intrauterine insemination in subfertile couples. Cochrane Database Syst Rev 2014;12:CD006942. DOI: 10.1002/14651858.CD006942.pub3.
  8. El Hachem H, Antaki R, Sylvestre C, et al. Timing therapeutic donor inseminations in natural cycles: human chorionic gonadotrophin administration versus urinary LH monitoring. Reprod Biomed Online 2017;35(2):174–179. DOI: 10.1016/j.rbmo.2017.05.005.
  9. Pellicer A, Albert C, Mercader A, et al. The follicularand endocrine environment in women with endometrioses; local and systemic cytokine production. Fertil Steril 1998;70(3):425–431. DOI: 10.1016/S0015-0282(98)00204-0.
  10. Wolff EF, Vahidi N, Alford C, et al. Influences on endometrial development during intrauterine insemination: clinical experience of 2,929 patients with unexplained infertility. Fertile Steril 2013;100(1):194–199. DOI: 10.1016/j. fertnstert 2013.03.023.
  11. Nuojua Huttunton S, Tomas C, Bloigu R, et al. Intrauterine insemination treatment in subfertility: an analysis of factors affecting outcome. Hum Reprod 1999;14(3):698–703. DOI: 10.1093/humrep/14.3.698.
  12. Edwards RG, Steptoe PC. Control of human ovulation, fertilization and implantation. Proc R Soc Med 1974;67(9):932–936.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.