2023년 유럽불임학회(ESHRE) P-599 The use of serum test to detect the LH surge in ultrasound-monitored intrauterine insemination (IUI) significantly increases pregnancy rates. (자궁강내 인공수정시 초음파 모니터링과 LH 급증을 혈청 검사로 감지 하면 임신율이 유의적으로 증가한다)

M.J. Kim¹, S.G. Kim¹, H.Y. Kim¹, J.S. Park¹, H.J. Son¹, G.W. Kim¹, G.D. Heo¹, J.Y. Seong¹, H.K. Noh¹, K.H. Lee¹.
¹Mamapapa&Baby Ob/Gy Clinic, Baby dream research center, Ulsan, Korea- South.

Study question

Could a serum test to detect LH surge in ultrasound-monitored IUI cycle improve pregnancy rates? 

Summary answer

Serum test to detect LH surges with ultrasound monitoring during IUI cycle significantly increased pregnancy rates. 

What is known already

IUI is known as the first line of treatment for infertile couples and is usually administered with human chorionic gonadotropin (hCG) before ovulation with clomiphene citrate (CC) or/and human menopausal gonadotropin (hMG) to ovarian known to stimulate. One of the key factor for IUI is that insemination should be performed close to ovulation time, as there are many reports that sperm injection at the ovulation time has a high pregnancy rates. However, there are still few reports on the optimal timing of ovulation for performing IUI. 

Study design, size, duration

The IUI performed from January 2016 through November 2022 (n=3187) was included in this study. A total of 875 patients underwent the IUI by inferring LH surge with procedure with serum test, while 2312 patients underwent the procedure IUI without the serum test (control).

Participants/materials, setting, methods

In this study included 3187 IUI cycle were analyzed. Controlled ovarian hyperstimulation was conducted with CC (100 ㎎/day) and hMG. Patients were divided into two groups with serum test or not test (control). The serum test group was monitored LH surge by inferring LH peak during IUI cycle. When the sufficient follicular size and endometrial thickness had been reached, hCG was administrated and insemination was performed. Pregnancy rates were compared by Chi-squared test. 

Main results and the role of chance

In each group, there were no significantly difference in age (34.4±3.7 vs. 34.7±3.7 years old) and endometrial thickness (8.8±2.2 vs. 8.9±2.2 ㎜) for IUI cycle condition. The serum test group was significantly higher clinical pregnancy rates compared to control group (19.0 vs. 15.7 % respectively) during IUI cycle (P<0.05). In addition, patients were classified according to the history of at least one or more failed IUI cycle. The clinical pregnancy rates was significantly higher in the serum test group than control group (21.6 vs. 10.8 % respectively) who history of at least one or more failed IUI cycle (P<0.001). 

Limitations, reason for caution

A limitation of this study has a too small size of the intervention group compared with the control group.

Wider implications of the findings

In our results, the serum test group had a significantly higher clinical pregnancy rates than the control group. Therefore, detecting a surge in LH with a serum test during the IUI cycle could predict the optimal timing of ovulation and thus increase the pregnancy rates.

한글요약

초음파 모니터링을 동반한 자궁내정액주입술(IUI) 시 혈청 검사를 통해 황체형성호르몬(LH) 서지를 확인하는 것이 임신율을 높이는지 알아보고자 했습니다. 2016년 1월부터 2022년 11월까지 3,187건의 IUI 사례를 분석한 후향적 연구로, 875명의 환자는 혈청 LH 검사를 통해 LH 서지를 추정하여 IUI를 진행했고, 2,312명의 대조군은 혈청 검사 없이 IUI를 받았습니다. 클로미펜 시트레이트(CC) 및/또는 인간 폐경성 고나도트로핀(hMG)으로 조절된 난소 과자극이 시행되었으며, 충분한 난포 크기와 자궁 내막 두께에 도달했을 때 hCG를 투여하고 주입술을 시행했습니다. 환자 연령(34.4±3.7세 vs. 34.7±3.7세)과 자궁 내막 두께(8.8±2.2mm vs. 8.9±2.2mm)에서는 그룹 간 유의미한 차이가 없었습니다. 혈청 검사 그룹의 임상 임신율은 19.0%로 대조군 15.7%보다 유의하게 높았으며(P<0.05), 특히 1회 이상 IUI 실패 경험이 있는 환자군에서는 혈청 검사 그룹의 임신율이 21.6%로 대조군 10.8%보다 훨씬 더 유의하게 높았습니다(P<0.001). 연구는 대조군에 비해 중재 그룹의 규모가 작다는 한계가 있지만, 혈청 LH 서지 검사가 최적의 배란 시기를 예측하여 IUI 임신율을 높일 수 있다는 중요한 시사점을 제공합니다.