A prospective, randomized study of pregnancy rates after transuterotubal and intrauterine insemination.

Abstract Objective To assess the relative efficacy, in terms of clinical pregnancy rates (PRs), of transuterotubal insemination versus the more traditional intrauterine insemination (IUI) procedure. Design Prospective, randomized, cross-over. Setting University-affiliated tertiary care center. Patients One hundred sixty infertile patients underwent 414 inseminations with or without controlled ovarian hyperstimulation. Interventions All patients were randomized in their initial cycle to transuterotubal insemination or IUI then crossed-over in subsequent cycles (n=191 total cycles of transuterotubal insemination and n=223 total cycles of IUI). Transuterotubal insemination was performed initially with ultrasound guidance, and then a tactile technique was used for the last 6months of the study. Main Outcome Measures Clinical PRs and complications after both insemination methods. Results The clinical PR per treatment cycle was 7% (13/191) after transuterotubal insemination and 7% (16/223) after IUI. The overall PR per patient was 18% (29/160). The incidence of ectopic pregnancy was 1 in 191 for transuterotubal insemination cycles and 0 in 223 for IUI cycles. Other complications included 3 vasovagal episodes with transuterotubal insemination and 1 with IUI. There was no clinical evidence of tubal infection, trauma, or perforation in either group. Conclusion Transuterotubal insemination did not appear to be associated with a higher PR when compared with IUI in this study. The potential for increased risk from complications related to the more invasive tubal technique does not appear to justify its use presently.