Ovarian stimulation medications and patients' responses as prognostic factors in IUI-treated infertile Saudi patients

Background: Intrauterine Insemination (IUI) remains the first thought of infertility treatment. Objective: To compare the stimulation effects and Pregnancy rate (PR) outcomes of two ovulation induction (OI) medications, human-derived menopausal gonadotrophins (hMGH), Merional (MER), and recombinant follicular stimulating hormone (rFSH), Puregon (PUR), in a cohort of Saudi infertile patients, for better predictability of treatment results. Materials and Methods: During a 24-month period, 296 women underwent IUI single treatments. PR's were correlated with the type of stimulation medication that were prospectively and randomly assigned to each patient, and with the number and size of maturing follicles detected on the hCG injection day. Results: MER and PUR needed comparable number of days (9.26±4.74 and 9.73±6.27 respectively) before follicles were ready for IUI, although the average amount used from MER, 1199.90 IU, was about double that was used from PUR, 621.08 IU. The overall PR in case of PUR however was nearly double that of MER, 13.28% and 7.14% respectively. The best PR, 16.22%, occurred when the follicles matured within 12-13 days. Three follicles of at least 15-mm diameter on the hCG day had better PR's than one or two, however when the follicles' diameters were at least 18-mm, PR was significantly higher, (p=0.013). Conclusion: MER and PUR had comparable stimulation effects; however PUR had noticeably higher PR. The best PR occurred when the follicles matured within 12-13 days. PR in case of three maturing follicles on the hCG day was better than only one or two, and significantly better when their diameters were at least 18 mm.