الفهرس 
Review of LiteratureOnly 14 pages are availabe for public view
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Abstract
Most couples seeking infertility treatment do not have problems rendering them completely unable to conceive. Rather, the couples have conditions associated with a relative decrease in the monthly likelihood of conception in which pregnancy can occur without treatment. Examples of subfertile conditions include unexplained infertility.
For all couples, the natural age related decline in fertility is also present regardless of the case of their reproductive problems. This biological clock is a significant issue for many couples, paralleling the demographic trend towards later marriage and childbearing.
As a consequence, patients and their physicians have gradually focused their efforts on newer options such as assisted reproductive technology, which may offer a non specific enhancement of cycle fecundity. The real issue is when these options can be used in a cost —effective manner.
Controlled ovarian hyperstimulation combined with intrauterine insemination of capacitated sperms has recently been used to treat a subtle of infertile couples in the absence of mechanical compromise of pelvic viscera, in whom no other efficacious treatment options exist.
PGs play a role in the physiological male and female process of reproduction, as it increase myometrial contractility, isthmic tubal relaxation,
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Summary and Conclusion
affect luteal maintenance , immunosuppression and enhance spermatozoon -
oocyte binding.
Due to the reported safety, widespread commercial availability and relative similarity of misoprostol to PGE , the usefulness of vaginally placed misoprostol as adjunctive therapy at the time of IUI was investigated .
The aim of this study was to evaluate the effect of the use of vaginal misoprostol at the time of WI and pregnancy rate among women with unexplained infertility undergoing IUI.
The study was designed as a prospective controlled cross over study and carried on the infertile couples attending the gynecology clinic of Benha University Hospital during the period from June 2003 to may2004.
Exclusions criteria included wife age above 35 years, woman with history of allergy or hypersensitivity to misoprostol and women with medical disorders which may contraindicate or be complicated with pregnancy as liver diseases, renal diseases, diabetes mellitus, thyrotoxicosis, epilepsy ...etc.
The protocol of ovarian stimulation was clomiphene citrate from day 3-7 and single dose hMG given on day 9. Ultrasound monitoring started from day 9 and every other day. When one of the follicle is 16-23 mm endometrial thickness is recorded, then 10.000 IU hCG is given IM
Sperm processing was done by the swim —up technique using Ham’s F10 media. 0.4 ml of the supernatant containing active sperms is used directly for IUI by Seminor R catheter after IUI 400 ug misoprostol vaginal tablets putted in the vagina.
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Summary and Conclusion
Micronized oral progesterone was given for luteal phase support in a dose of 200 mg for 10 days. Pregnancy was diagnosed by detection of serum B subunit hCG and confirmed later by T.V U/S examination.
A total of 251 inseminations were done in six treatment cycles 125were IUI with misoprostol and 126 were IUI without misoprostol.
A total of 12 pregnancies occurred giving an overall pregnancy rate per patient of 24% and 4.78% per cycle. the higher pregnancy rate in IUI with misoprostol was (28% and 5.6%) per patient and cycle, in comparison to (20% and 3.96%) in IUI without misoprostol.
There was insignificant different regarding women and husband age, number of follicles, endometrail thickness and sperm characters before and after processing among pregnant and non pregnant group.
No complications were recorded during this work. Minor side effects included difficult application in 6cases with one case in misoprostol group in comparison to 5 cases of the second group(sperm reflux in 3cases of which 2cases with misoprostol group, 1 case of vaginal bleeding in misoprostol group and abdominal cramp in 2 cases of IUI with misoprostol and 1 case of IUI without it ).
We achieved 12 cases of pregnancy, out of which 10 cases were single pregnancy and 2 cases of twin pregnancy.
Comparison between the number of pregnancy after IUI with vaginal misoprostol and that without misoprostol suggestive of increasing number of pregnancy in the first group in comparison to the second group (7-5 respectively).
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Summary and Conclusion
CONCLUSION
1.Vaginal misoprostol increase the pregnancy rate with COH+IUI.
2.Higher pregnancy rate in COH + IUI occur in the first three treated
cycles than in the next three cycles.
3.In COH with clomiphene citrate and single dose of HMG +IUI
pregnancy is mostly single.
4.More researches is needed to evaluate the effect of vaginal
misoprostol in IUI before establishment of the drug.