Pozzi Forceps in Intrauterine Insemination
Palabras clave
Abstracto
Descripción
Once the initial investigations are done, an oral treatment is started on the first cycle if medically indicated.
At mid-cycle, patients undergo a transvaginal ultrasound looking for follicles' maturation. This ultrasound's goal is to detect ovulation and plan the IUI. If no follicle is detected, the transvaginal ultrasound is repeated later. If there is no luteinizing hormone (LH) peak detected upon ovulation urine test, there will be an ovulation induction with human chorionic gonadotropin (hCG) based depending on patient's age, number and size of detected follicles. Subcutaneous hCG or intramuscular hCG can be used. A cycle can be cancelled if there is no ovulation or if there is ovarian hyperstimulation.
During ovulation, semen analysis is performed, looking at sperm volume, sperm concentration and mobility. Then, semen is treated with a density gradient or with centrifugation. Isolated sperm are diluted in 0.5 to 1 mL of media and maintained in an incubator at a 37 º C temperature until insemination. The laboratory performs a second analysis on the washed semen in order to obtain the most accurate measures. If donor's semen is used, the andrology laboratory prepares the specimen and then processes with the semen analysis.
Patients are inseminated the day after a spontaneous LH peak or 24-36h after ovulation induction. For those who are randomized to the intervention group, a pozzi tenaculum forceps will be applied and clamped horizontally to the anterior cervical labrum with only a single click and mild traction will be applied in another to decrease the uterocervical angle. When no tenaculum is applied, motion will be mimicked without actual tissue prehension. Patients randomized to the control group will only have a tenaculum forceps applied in cases where the IUI is not feasible otherwise by the gynecologist. Indeed, it is sometimes necessary, when the cervical anatomy does not allow for easy pass of the catheter, for a pozzi tenaculum forceps to be used in order to insert the insemination catheter properly in the uterine cavity. In that case, tenaculum use will be recorded in the patient's file. No cervical insemination is allowed. Insemination is performed with flexible catheters and care is taken to avoid touching the uterine fundus with the catheter tip. There are multiple catheters available in the gynecology clinic, namely catheters The Curve (Cooper Surgical, Berlin), Shapeable IUI Catheter (Thomas Medical, Indianapolis) and Mini space (Laboratory C.C.D., Paris). After the intervention, patients are instructed to lie flat for 10 minutes after which they go home until next appointment.
Intercourse is allowed following IUI treatments. Patients are instructed to perform a urinary pregnancy test at home to weeks after the IUI, which will be provided to them. If the test is positive, patients are scheduled for a transvaginal ultrasound on week #7 of amenorrhea to confirm proper intrauterine pregnancy evolution. When pregnancy is confirmed, patients are referred to an physician for obstetrical follow-up.
In case of treatment failure, patients go on with ovulation induction or stimulation for the next cycle as previously prescribed by the gynecologist at mid-cycle ultrasound, if indicated. Dosages of ovarian stimulation medication may be modified, at physician's discretion, in order to optimize response to treatment according to the usual indications (ovarian hyperstimulation, side effects, poor response, etc.) Patients will be followed for 3 cycles and, if need be, can receive subsequent IUI treatments outside research protocol.
fechas
Verificado por última vez: | 12/31/2019 |
Primero enviado: | 02/02/2018 |
Inscripción estimada enviada: | 02/14/2018 |
Publicado por primera vez: | 02/18/2018 |
Última actualización enviada: | 01/22/2020 |
Última actualización publicada: | 01/26/2020 |
Fecha de inicio real del estudio: | 05/31/2019 |
Fecha estimada de finalización primaria: | 09/30/2020 |
Fecha estimada de finalización del estudio: | 12/31/2020 |
Condición o enfermedad
Intervención / tratamiento
Procedure: Intrauterine insemination
Fase
Grupos de brazos
Brazo | Intervención / tratamiento |
---|---|
Active Comparator: Pozzi for intrauterine insemination Treatment done with a pozzi tenaculum forceps | |
Active Comparator: No Pozzi for intrauterine insemination Treatment done without a tenaculum forceps |
Criterio de elegibilidad
Edades elegibles para estudiar | 18 Years A 18 Years |
Sexos elegibles para estudiar | Female |
Acepta voluntarios saludables | si |
Criterios | Inclusion Criteria: - Infertility :Defined as no pregnancy after one year of regular unprotected vaginal intercourse - Infertility secondary to endometriosis, to a mild to moderate male factor, to an ovulatory dysfunction, an unexplained infertility or any other known medical indication for IUI. - Intrauterine insemination with a partner's semen sample or a donor sample - First IUI treatment or first treatment since last pregnancy - Ovulation induction with letrozole medication - Being able to speak and understand French Exclusion Criteria: - Bilateral tubal occlusion - Active pelvic infection - < 1 X 10^6 mobile sperm on semen analysis |
Salir
Medidas de resultado primarias
1. Rate of live births [At the end of 1 cycle (approximately 28 days)]
Medidas de resultado secundarias
1. Clinical rate of pregnancy [At the end of 1 cycle (approximately 28 days)]
2. Patients' global satisfaction [15 minutes after the intervention]
3. Pain Level [15 minutes after the intervention]