Outcome of Single and Double Intrauterine Insemination Techniques in Infertility Cases

Background: Primary infertility is a serious condition that has a profound impact on the mental and physical health of the couple, and the condition forms a significant proportion of cases seeking treatment at gynecological centers across the world. Intrauterine insemination (IUI) forms the cornerstone in the management of most of such cases. However, there has been an ongoing debate regarding whether single IUI or double IUI: which is better. This randomized control trial aims at comparing the outcomes of both the techniques. Materials and Methods: In this randomized control trial, 150 couples having a valid indication for IUI were randomized into two groups. In the first group, single IUI was done at 36 h after human chorionic gonadotropin (HCG) trigger, and in the second group, double IUI was done at 24 and 48 h post-HCG trigger. The outcome measured was pregnancy which was confirmed by urine pregnancy test done on the 18th day after IUI and later followed up till appearance of gestation sac with fetal pole on ultrasound. The Fisher's exact test for statistical analysis was used to analyze the data for statistical significance. Results: In the single IUI cohort of 75 women, 11 tested positive for urine beta-HCG on day 18 and all had confirmed pregnancy (gestational sac with fetal pole). The pregnancy positivity rate for this cohort was 14.67% (11/75 x 100%). In the double IUI cohort of 75 women, 13 tested positive for urine beta-HCG on day 18 and all had confirmed pregnancy (gestational sac with fetal pole); the pregnancy positivity rate for this cohort was 17.33% (13/75 x 100%). Although the double IUI group had a higher yield of positive outcomes, the result was not statistically significant (statistic test value is 0.8242). Conclusion: The outcome of single versus double IUI is almost similar. In a resource-poor situation, it will be prudent to stick to single IUI in all cases requiring IUI. However, in a resource-rich situation, one might resort to double IUI in male factor abnormalities such as asthenozoospermia or borderline oligozoospermia.