الفهرس 
Review of LiteratureOnly 14 pages are availabe for public view
 |  | from | 200 |  |  |
| | | from | 200 | | |
Abstract
For couples with cervical factor infertility, unexplained inferitlity or male suhfertility there is no specific method of treatment. Attempts to improve the success rate with regard to pregnancy have included washing the sperm, which concentrate the more motile fraction and may temporarily remore the effect of antiserum antibodies ; depositing the sperm closer to the point of fertilization in the fallopian tubes, thus over coming possible sperm progression deficiencies; and increasing the number of oocytes available for fertilization with avarian stimulation.
Various treatment that incorporate one or more of these techniques have been described. These include AIH, IVF- ET, GIFT and others.
DIN was first described by Fortier et at, (1986 a) as a form of assisted reproduction which is safe, simple, inexpensive and not need sophisticated technology as in IVF- ET or GIFT and so can he used in small infertility clinics within the patient locality.
The method avoids exposure of the spermatozoa to the cervical mucus and the uterine secretion as well as facilitate their transportation to the peritoneal cavity, a site they are known to reach after sexual intercourse.
After the first report of forrler, et at, (1986 a), direct
intraperitreal insemination (DIPI) of capacitated spermatozoa, in
combination with induced and timed ovulation, has been used by several groups in cases of cervical factor, male factor, unexplained
-157-
Summary& Conch/um
infertility and immunological infertility (Crossignani et al., 1991, Turhan et al, 1992 , Korlstro► et al., 1993, Ei tagy et al., 1995) and showed divergent results
This study was concluded to evaluate the role of DIP1 in treatment of couples with cervical, unexplained infertility and male suhfertility as a new infertility treatment which is a successfill method, easier and cheapest than GIFT or 1VF-ET. and to compare this method with the controlled timed iniercourse.Also to gel experience in the preparation of the semen for artificial insemination and the technique of direct intraperitoneal insemination.
This study included 63 couples suffering from infertility ( primary infertility 53 couples and secondary infertility 10 couples) classified into three categories; cervical factor infertility 21 couples, unexplained infertility 21 couples and suhfertile oligo asthenozoospermic group 21 couples, attending the obstetrics and Gynecology Department of Benha university hospital and its outpatient clinics. The mean age and mean duration of infertility were matched in the three groups. All patients were selected to have normal patent tubes with no organic pathology
in the pelvis.
Each patient of the three groups was followed up for 6 months (cycles), where direct intraperitoreal insemination following clomiplicne citrate 100mg for 5 days (3-7) and ovarian monitoring was carried out on three alternating cycles, while the cycle before and all the cycles between DIPI cycles served as control cycles (ovarian stimulation with clomiphere citrate 100 mg in addition to monitoring
-15X-
Summary AA lionehnints
and timed intercourse). The effectiveness of DIPI and the success of treatment were determined by the occurrence of pregnancy and any complications raised during the treatment, as compared to controlled timed intercourse .
The results of this work demonstrated that:
I- Pregnancy rate per patient was 17.5% (11/63) among DIPI treated couples
2-Pregnancy rate per cycle was 6.4 (11/ 173) among DIPI treated cycles.
3-No pregnancy could be achieved in the controlled timed intercourse cycles (zero%)
4_ In group 1 (cervical factor) we achieved 14.3% pregnancy rate / patient and 5.4% pregnancy rate /cycle.
5-In group II (unexplained infertility) we achieved 19% pregnancy rate / patient and 6.9% pregnancy rate / cycle.
6-In group III (subferfile male) we achieved 19% pregnancy rate / patient and 6,7% pregnancy rate / cycle.
7-Abortion rate was 18% (2/11 )
8-No complications could be detected during the study.
9-There was no statistically significant difference between the three groups as regard to the mean age of wives or husbands, duration of infertility or the type of infertility .
I 0-Washing and swim-up technique was effective technique for semen preparation heibre DIPI.
I I- The pregnancy rate decrease with increasing the age of patients.
-1 59-
S ttttttt ry If! Gone/ ........
12-Increase the number of follicle stimulated increase the chance of pregnancy.
13-The chance of pregnancy increased with increasing the count and motility of sperms transferred in the subgertile group.
14- The mean age of wife in the unexplained infertility group was significantly lower in patients who get pregnant than the non pregnant.
Conclusion
this study proved that combined therapy by clomiphere citrate and hCG and DIPI have significant increase in the success rate of achieving pregnancy than the combined therapy by clomiphene citrate and hCG and controlled timed intercourse.
Direct intraperitoneal insemination combined with controlled avarian hyperstimulation offers a simple and alternative method for the treatment of couples with cervical factor infertility, unexplained infertility or male subfertility. The treatment appears to increase the cycle fecundity and shorten the duration of infertility (6.4%). In spite of the pregnancy rate was less than abtained by other authors (Crosieani el at, 1991; Turban et at, 1992; Evans et at, 1991 and Karlskom el at, 1993) because of the difference in the hyperstimulation protocols, large number of patients, different methods of sperm preparation and experience.
Further studies with changing the protocol of ovarian stimulation, and improving the technique of insemination by using vaginal uhrasonography are necessary to assess the efficacy of DIPI. however,
-160-
............5/ 41 Unnehnion
the technique is considerably less invasive, does not require sophisticated laboratory equipment, less expensive and does not prohibit the couple from attempting further treatment, such as GIFT or I VF-ET if initially unsuccessful.
Recommendation
OThis technique of insemination can be applied to any patient complaining of unexplained infertility, cervical factor infertility or male sublertility in small infertility clinics in their locality before. considering the more invasive and costly GIFT or IVF-ET as this technique is so simple, inexpensive and acceptable and offers a reasonable success rate.
OProper timing of ovulation and insemination must be considered to obtain good results.
OProper processing of semen to improve its quality must he done prior to insemination
OThe procedure must he done tinder complete aseptic condition to avoid infection.
OMore studies on the peritoneal fluid with infertility and sperm peritoneal fluid migration test in recommended to be done before DIN to recognize the hostile peritoneal invironment. This will permit orientation of patients to the most suitable treatment, for these patients in vitro fertilization may he the best solution.
OFurther studies on DIPI with using different protocol of ovarian stimulation and semen preparation, using of vaginal ultrasonography
ti
-16I-
11111111117131 ef. Conchnion
in moritoring of ovulation and during intraperitonal insemination to test the efficacy of this insemination technique properly.
O The psychological aspect of infertile couples who are going to do DIPI must be taken into consideration and the physian dealing with them must he honest, polite and patient.
O Comparative studies between DIPI, 1111 and combined IUI + DIPI to test the efficacy of such simple techniques.