A prospective randomized trial of artificial insemination versus intercourse in cycles stimulated with human menopausal gonadotropin or clomiphene citrate

Objective To determine the relative efficacy of intrauterine insemination (IUI), direct intra-peritoneal insemination, and intercourse in cycles stimulated with clomiphene citrate (CC) or human menopausal gonadotropins (hMG). Design A prospective randomized trial with a 2 3 factorial design with eight different treatment alternatives. Only one cycle per couple was performed. Settings The Departments of Obstetrics and Gynecology, Central Hospital, Vasteras and Akademiska Hospital, Uppsala University, Uppsala, Sweden. Patients Of 157 randomized couples with unexplained infertility including 51 cases with minimal or mild endometriosis, 148 were selected for comparison. Main Outcome Measure Pregnancy rate (PR). Results Follicular stimulation with hMG gave a higher PR than with CC in the insemination cycles, 19% (10/52) and 4% (2/49), respectively, but the PRs in intercourse cycles were not significantly different for hMG and CC, 13% (3/24) and 17% (4/23), respectively. Insemination cycles and intercourse cycles had a similar overall PR, 12% (12/101) and 13% (7/47), respectively. Furthermore, IUI and direct intraperitoneal insemination did not differ in efficacy. Conclusion Follicular stimulation with hMG is more effective than CC in insemination cycles, but insemination as such seems to have no beneficial effect on the PR in stimulated cycles for treatment of unexplained infertility.