Comparative Study of Intrauterine Insemination Versus Fallopian Tube Sperm Perfusion in the Management of Non-Tubal Infertility

Background: Controlled ovarian hyperstimulation (COH) combined with intrauterine insemination (IUI) is a commonly used treatment modality for couples with non-tubal infertility. Fallopian tube sperm perfusion (FSP) is an alternative technique in which a larger volume of processed sperm suspension is injected under pressure while minimizing semen reflux through cervical sealing. This technique may increase the concentration of motile sperm reaching the fallopian tubes at the time of ovulation. The present study aimed to compare the effectiveness of standard IUI and FSP in the treatment of non-tubal infertility. Material and Methods: A total of 110 women with non-tubal infertility undergoing 110 stimulated cycles were enrolled in this prospective randomized study. Fifty-five patients underwent standard IUI following controlled ovarian stimulation with letrozole 2.5 mg (Group A), while 55 patients underwent FSP following the same stimulation protocol (Group B). Semen preparation was performed using the double-density centrifugation and swim-up technique in all cases. Insemination was performed 36–40 hours after human chorionic gonadotropin (hCG) administration. A volume of 0.5 mL inseminate was used for standard IUI, whereas 3 mL inseminate was used for FSP. Results: In Group A, 10 clinical pregnancies were achieved among 55 IUI cycles, resulting in a pregnancy rate of 18.2%. In Group B, 15 clinical pregnancies were achieved among 55 FSP cycles, resulting in a pregnancy rate of 27.3%. Clinical pregnancy was defined as the presence of a gestational sac with fetal cardiac activity on ultrasonography. "The clinical pregnancy rate was higher in the FSP group (27.3%) than in the IUI group (18.2%); however, the difference did not reach statistical significance." Conclusion: Fallopian tube sperm perfusion demonstrated a higher clinical pregnancy rate compared with standard intrauterine insemination in women with non-tubal infertility. FSP can be considered an effective alternative to conventional IUI in appropriately selected patients.

Keywords: Intrauterine insemination; Fallopian tube sperm perfusion; Non-tubal infertility; Controlled ovarian hyperstimulation; Clinical pregnancy.