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Hum. Reprod. Advance Access published online on February 15, 2008
Human Reproduction, doi:10.1093/humrep/den003
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© The Author 2008. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

A new rapid and effective method for treatment of unexplained infertility

Greta Edelstam1,2,5, Anette Sjösten2,3, Kerstin Bjuresten1, Ingvar Ek1, Kjell Wånggren1,2 and Jack Spira2,4

1 Department of Obstetrics and Gynaecology, Karolinska University Hospital, Huddinge, SE-141 86 Stockholm, Sweden 2 Karolinska Institutet, SE-171 77 Stockholm, Sweden 3 Läkargruppen Victoria, Söderhallarna 120, SE-118 72 Stockholm, Sweden 4 InSpira Medical, Näsbyvägen 38, SE-135 53 Tyresö, Sweden

5 Correspondence address. Fax: +46-87-18-23-84; E-mail: greta.edelstam{at}karolinska.se

BACKGROUND: Artificial insemination (intrauterine insemination by husband or artificial insemination by husband) is often tried as first treatment for couples with unexplained infertility. Pertubation has previously proved to increase the chance of achieving pregnancy for these couples. The effect of pertubation on fertility can be mechanical as well as anti-inflammatory by using a substance that inhibits phagocytosis of the spermatozoa. The objective of the study was to investigate the effect on pregnancy rate of pre-ovulatory pertubation with low-dose lignocaine during clomiphene citrate and insemination cycles for couples with unexplained infertility.

METHODS: In a prospective, open study, the patients were randomized, the day before ovulation, during a clomiphene citrate stimulated cycle to either pertubation with low-dose local anaesthetic or no pertubation before insemination.

RESULTS: A total of 130 cycles were studied, 67 of which were randomized to pre-ovulatory pertubation and 63 to no pertubation treatment. There were 14.9% (n = 10) clinical pregnancies in the pertubated group compared with 3.2% (n = 2) in the group without pre-ovulatory pertubation (P < 0.05).

CONCLUSIONS: The pertubation treatment significantly enhanced the clinical pregnancy rate and was well tolerated. No complications were noted. The combined treatment of clomiphene citrate, pertubation and insemination can be used as a cost-effective, first-line treatment for couples with unexplained infertility.

Key words: pertubation/tubal flushing/unexplained infertility/clomiphene citrate/intrauterine insemination

Submitted on March 15, 2007; resubmitted on November 19, 2007; accepted on December 4, 2007.


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