Aim: To assess the impact of intrauterine injection of human chorionic gonadotropin before intrauterine insemination (IUI) compared to IUI alone on the pregnancy and live-birth rates in women with unexplained infertility (UI).
Methods: A randomized controlled trial included 210 women with UI underwent combined ovarian stimulation and IUI. Patients scheduled into two equal groups. The study group, allocated to uterine flushing with HCG (500 IU) one day before IUI and control group allocated to IUI alone. The primary outcome was the difference in the live birth. Secondary outcomes were the differences in chemical and clinical pregnancy and the adverse reactions in both groups. Results: One-hundred patients finished the study in each group. Significantly higher rates of chemical pregnancy (25% vs. 13%; p=0.031), clinical pregnancy (22% vs. 11%; p=0.037), and live birth (19% vs. 9%; p=0.042) were noted in HCG uterine flushing group compared to the controls. However, no difference was noted between both groups regard rates of abortion (p=0.037) and multiple gestations (p=0.2). No case of ectopic pregnancy occurred in either arm of the study. The HCG uterine flushing group had a significantly higher frequency of pain (39% vs. 21%; p=0.006) compared to the controls. No differences were noted between both groups regard nausea (9% vs. 4%; p=0.162), vomiting (5% vs. 1%; p=0.135) and vaginal bleeding (8% vs. 2%; p=0.07).
Conclusion: Uterine flushing with HCG before IUI may offer a promising, simple, inexpensive, tolerable choice for increasing pregnancy and live birth rates in women with UI.