Role of treatment with ovarian stimulation and intrauterine insemination in women with unilateral tubal occlusion diagnosed by hysterosalpingography.

OBJECTIVE

To assess the value of controlled ovarian hyperstimulation (COH) and IUI in women with unilateral tubal occlusion diagnosed by hysterosalpingography. Hysterosalpingography (HSG) is the most common screening test for tubal pathology. The management of patients with unilateral tubal occlusion is vague, and studies of treatment results with COH and IUI are scarce.

DESIGN

Retrospective, case-controlled study.

SETTING

Referral infertility clinics of a national health service.

PATIENT(S): The study group consisted of 62 consecutive patients treated at our centers for isolated unilateral tubal occlusion by HSG between 1998-2005. In all cases, menstrual cycles were regular, and day-3 FSH levels and sperm counts were normal. The control group consisted of 115 patients with unexplained infertility treated during the same time period.

INTERVENTION

All patients were treated primarily with three consecutive cycles of COH and IUI, with the use of standard protocols of ovarian stimulation with gonadotropins. Data analysis included basic clinical parameters, response to ovarian stimulation, inseminated sperm parameters, and pregnancy rates (PRs).

MAIN OUTCOME MEASURE

Cumulative PR for three cycles of COH and IUI.

RESULT(S): There were no between-group differences in basic clinical and sperm parameters. The cumulative PRs after three cycles of COH and IUI were 30.9% for the study group, and 42.6% for the control group. The cumulative PR in women with mid-distal or distal tubal occlusion was lower, but not of greater statistical significance, than in women with proximal tubal occlusion (19% versus 38.2%), and was significantly lower than in women with unexplained infertility (19% versus 42.6%).

CONCLUSION(S): Controlled ovarian hyperstimulation with IUI should be suggested as the initial treatment of choice in patients with unilateral proximal tubal occlusion. The results are similar to those in patients with unexplained infertility. However, the outcome of COH with IUI is worse in patients with mid-distal or distal tubal occlusion on HSG, who should be referred for laparoscopic assessment or IVF.