الفهرس 
Subjects nd methodsOnly 14 pages are availabe for public view
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Abstract
SUMMARY & CONCLUSION
SUMMARY & CONCLUSION
Most couples seeking infertility treatment do not have
problems rendering them completely unable to conceive.
Rather, the couples have conditions associated with a relative
decrease in the monthly likelihood of conception in which
pregnancy can occur without treatment. Examples of
subfertile conditions include endometriosis , oligoasthenospermia
, idiopathic infertility, minimal adnexial adhesions,
ovulatory dysfunction and cervical factor infertility.
For all couples, the natural age related decline in fertility
is also present regardless of the case of their reproductive
problems. This biological clock is a significant issue for
many couples , paralleling the demographic trend towards
later marriage and childbearing.
As a consequence , patients and their physicians have
gradually focused their efforts on newer options such as
assisted reproductive technology , which may offer a non
specific enhancement of cycle fecundity. The real issue is when
these options can be used in a cost - effective manner.
Controlled ovarian hyperstimulation combined with intrauterine
insemination of capacitated sperms has recently been used to
treat a subtle of couples infertile in the absence of mechanical
compromise of pelvic viscera, in whom no other efficacious
treatment options exist.
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SUMMARY & CONCLUSION
The aims of this study were to review indications and methods
of AIH and to evaluate the FAST -system as a method ofFSP in
the treatment of selected cases of infertility in comparison to
the standard traditional IUI.
The study was designed as a prospective controlled cross
over study and carried on the infertile couples attending the
infertility care clinic of Benha university hospital during the
period from February 1998 to October 1999.
Exclusions criteria included wife age above 40 years,
husband with a sperm count below 5XI0(6) .Iml and infertile
couples due to multiple factors.
100 Couples were treated and included four groups:
Group 1 : Subnormal semen, 33 cases.
Group 2: Unexplained infertility, 30 cases.
Group 3 : Cervical factor infertility, 20 cases.
Group 4: Polycystic ovaries, 17 cases.
The protocol of ovarian stimulation was CC from day 3-7
and single dose hMG given on day 9. Ultrasound monitoring
started from day 9 and every other day. When one of the follicle
is 18 mm or more, endometrial thickness and cervical mucus
score are recorded, then 10.000 IU hCG is given 1M.
Insemination was performed 30-36 hours later.
Sperm processing was done by the swim-up technique using
Ham,s FlO media. 0.4 ml of the supernatant containing
active sperms is used directly for lUI by Gynetics catheter
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SUMMARY & CONCLUSION
or diluted to 4 ml with Ham,s media for FSP by the
FAST-system.
Micronized oral progesterone was give for lutael phase
support in a dose of 200 mg for 10 days.
Pregnancy was diagnosed by detection of serum B subunit hCG
and confirmed later by U/S examination, chemical pregnancy
was excluded from the results.
A total of 227 inseminations were done in three treatment
cycles. 116 were lUI ( 51.1 %) and III were FSP (48.9 %).
A total of 12 pregnancies occurred giving an overall
pregnancy rate per patient of 12 % and per cycle of 5.3% .
The highest pregnancy rate occurred in the cervical factor
infertility group ( 15 % and 7 %) and the lowest was in the
subnormal semen group (9.1 % and 3.7 %) .
In lUI the pregnancy rate per cycle in the subnormal semen
group was the lowest being 2.4% , in the unexplained infertility
group it was 5.4%, in the cervical factor infertility group 4.8%
and 5.9 % in the pca group.
In FSP the pregnancy rate per cycle was 5% in the subnormal
semen group, 5.9 % in the unexplained infertility group,
9.1 % in the cervical factor infertility group and 6.7 % in
the pca group.
The highest pregnancy rate per cycle occurred in the first
treatment cycle ( 7 %) then it dropped to 4 % and 3.8 % in
the second and third treatment cycles; a difference which is
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SUMMARY & CONCLUSION
not significant.
Pregnant cases had a significantly younger age and shorter
duration of infertility. All pregnant cases aged 34 years or
below and all had 8 years infertility or less. Husband age was
not a significant factor.
There were no significant difference between pregnant and non
pregnant cases in relation to the number of follicles 18 mm or
more, endometrial thickness and cervical mucus score recorded
on the day of hCG injection.
The swim-up technique used for sperm processing significantly
decreases sperm concentration and increases sperm progressive
motility.
In the subnormal semen group pregnant cases had significantly
higher sperm concentration and motility both before and after
processing than non pregnant cases. Also, the number of
sperm inseminated was significantly higher in pregnant cases.
In normospermic husbands no difference in sperm parameters
was found between pregnant and non pregnant cases.
However, all pregnant cases had more than 5 X 10(6)
sperms in the inseminate.
No complications were recorded during our work. Minor side
effects included sperm reflux in 2 cases of lUI and 8 cases
of FSP. Difficult application of the insemination cannula in lUI
was present in 5 cases and in 18 cases with the FAST-system.
One case of vasovagal attack and two cases of abdominal cramps
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SUMMARY & CONCLUSION
occurred with FSP.
We achieved 12 cases of pregnancy, out of which 2 cases
aborted, 9 cases were single full term pregnancy and one
case of twin pregnancy.
Comparison between the number of pregnancy after lUI and
FSP shows that there was no significant difference between
both methods in the four studied groups.
We can conclude from our study the following remarks:
I-In all types of infertility treated with AI, younger wife
age and shorter duration of infertility has a great influence on
the success of treatment.
2- CC and single dose gonadotrophin for ovanan stimulation
IS an easy method , without serious complications and needs
no sophisticated hormonal follow up beside its low cost, so
it is suitable in our centers.
3- Swim-up technique causes wastage of a great number of
sperms , so in sever oligospermia with a sperm count below
5 X I0(6) Iml, another method of sperm processing is essential
(e.g Percoll gradient) .The number of progressive motile sperm
in the inseminate is also important; a number of 5 X 10(6) is
minimally required for AI.
4- FAST - system as a method of FSP offers no advantages
on lUI, beside having more side effects and is more expensive.
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SUMMARY & CONCLUSION
Our recommendations are:
I-Results of artificial insemination are promising, so it should
be considered as the first choice in the treatment of non tubal
infertility if assisted reproduction is recommended.
2- Early interference m a young infertile couple after short
duration of infertility is advised.
3- AI procedure could be tried for more than three cycles, in
some selected cases of infertility
4- In PCO artificial insemination IS indicated after failure to
conceive with ovulation induction and timed intercourse, and
before any surgical intervention.
5- In our society couples need more information about the
procedure and more clarification regarding the ethical and
religion point of view with real image to expected results.
6- In the future researches ; data of patients and details of the
methodology should be carefully reported for easy and correct
comparison of results of different studies, this will help to get
the best results of AI.
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