Comparative study between intrauterine insemination following preovulatory pertubation versus intrauterine insemination alone in induced ovulation cycles in infertility patients

Pranjali Dhume
International Journal of Reproduction, Contraception, Obstetrics and Gynecology · 2022 · vol. 11(2) , pp. 455 · doi:10.18203/2320-1770.ijrcog20220169 · W4210635968
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⚙ AI-generated summary by gemini-2.5-flash-lite, 2026-06-09 ⓘ

This study found that preovulatory perturbation with low-dose lignocaine followed by IUI showed a trend towards increased pregnancy rates compared to IUI alone, particularly in endometriosis patients, with no significant safety concerns.

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This randomized comparative study evaluated 60 ovulation induction cycles in infertility patients receiving intrauterine insemination (IUI) after clomiphene citrate or gonadotrophins, comparing IUI alone versus IUI preceded by preovulatory perturbation using low-dose lignocaine in balanced salt solution administered 10–12 hours after ovulation trigger. The primary outcome was conception measured by a positive urine pregnancy test, with secondary outcomes including full-term pregnancy, abortion, ectopic pregnancy, and procedural harms such as pain, infection, hemorrhage, and long-term complications. Pregnancy rates were numerically higher with lignocaine perturbation (20.6%) than IUI alone (14.7%), but the difference was not statistically significant (p>0.05), and the intervention was reported as safe, with mild to moderate pain common and one case of syncope and one case of post-procedure PID. Relevance to endometriosis: the authors report that spontaneous pregnancy rates in endometriosis were <5% and that conception rates in the intervention group were 37.5% among cases with endometriosis, though the overall trial results between groups were not statistically significant; this paper’s main focus is a perturbation-versus-no-perturbation comparison in induced ovulation IUI cycles.

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Abstract

Background: To compare the efficacy of pertubation with low dose lignocaine before ovulation followed by intrauterine insemination versus intrauterine insemination alone in induced ovulation cycles in infertility patients.Methods: Total 60 ovulation induction cycles were studied, were randomly divided in Group A and Group B of 30 cycles each. Ovulation induction was done with clomiphene citrate / gonadotrophins. Post ovulation IUI was done in both the groups. Additionally, preovulatory pertubation with low dose lignocaine diluted in balanced salt solution was done 10-12 hrs after ovulation trigger in group A. The primary outcome conception (positive urine pregnancy test) in patients were compared between two groups. The secondary outcomes, full term pregnancy, abortion, ectopic pregnancy, procedural pain, infection, haemorrhage, and long term complications were also studied and compared.Results: Pregnancy rate was found to be slightly more in the preovulatory perturbation with low dose lignocaine and IUI group (20.6% in Group A) as compared to IUI alone group (14.7% in Group B). But the difference was not found to be statistically significant (p>0.05). The spontaneous pregnancy rates in patients with endometriosis is <5%. In the intervention group it was 37.5% in cases with endometriosis, which was encouraging. The pertubation treatment used in this study proved to be a safe treatment option without complications. Procedure was associated with mild to moderate pain in 76% patients and severe in 8.8% patients and one patient (2.9%) had syncope. Post procedure PID was noted in one patient (2.9%).Conclusions: Preovulatory perturbation followed by IUI was associated with increased clinical pregnancy rate as compared with IUI alone in induced ovulation cycles. The efficacy was more pronounced in the patients with endometriosis. It is safe and well tolerated.
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Background

To compare the efficacy of pertubation with low dose lignocaine before ovulation followed by intrauterine insemination versus intrauterine insemination alone in induced ovulation cycles in infertility patients.

Methods

Total 60 ovulation induction cycles were studied, were randomly divided in Group A and Group B of 30 cycles each. Ovulation induction was done with clomiphene citrate / gonadotrophins. Post ovulation IUI was done in both the groups. Additionally, preovulatory pertubation with low dose lignocaine diluted in balanced salt solution was done 10-12 hrs after ovulation trigger in group A. The primary outcome conception (positive urine pregnancy test) in patients were compared between two groups. The secondary outcomes, full term pregnancy, abortion, ectopic pregnancy, procedural pain, infection, haemorrhage, and long term complications were also studied and compared.

Results

Pregnancy rate was found to be slightly more in the preovulatory perturbation with low dose lignocaine and IUI group (20.6% in Group A) as compared to IUI alone group (14.7% in Group B). But the difference was not found to be statistically significant (p>0.05). The spontaneous pregnancy rates in patients with endometriosis is <5%. In the intervention group it was 37.5% in cases with endometriosis, which was encouraging. The pertubation treatment used in this study proved to be a safe treatment option without complications. Procedure was associated with mild to moderate pain in 76% patients and severe in 8.8% patients and one patient (2.9%) had syncope. Post procedure PID was noted in one patient (2.9%).

Conclusions

Preovulatory perturbation followed by IUI was associated with increased clinical pregnancy rate as compared with IUI alone in induced ovulation cycles. The efficacy was more pronounced in the patients with endometriosis. It is safe and well tolerated. Metrics

References

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