Effect of Intrauterine Navigation Using Intrauterine Insemination Catheter for Mock Embryo Transfer Prior to Day 3 Embryo Transfer on Pregnancy Rate: A Pilot Study

Materials and Methods Population Forty-five patients were selected for this prospective randomized control trial. It was conducted between October 2016 and October 2017 in the Reproductive Endocrinology and Infertility Medicine Department of King Fahad Medical City (KFMC).

We included nulliparous patients who were < 42 years of age with body mass index (BMI) < 30 kg/m2 and normal endometrial cavity, used fresh sperm or oocytes, had two or more embryos available for transfer on day 3 post ovum pick-up (OPU), and no more than 3 previous unsuccessful ART cycles. Patients with uterine fibroids, uterine anomalies, intra-uterine adhesions, and uterine polyps, patients with chronic diseases in the as uncontrolled diabetes or hypertension, or if the patient had difficult mock ET . patients with severe male factors for infertility requiring surgical retrieval of sperms were excluded from the study.

Ethical clearance of this study was obtained from the ethical committee of KFMC (IRB 00008644). Written informed consent was obtained from all the participants.

Stimulation Protocols Participants were assigned either to the antagonist or agonist protocol. In the agonist stimulation protocol, pituitary desensitization was achieved by using 3.75 mg leuprolide acetate (Lupron Depot, Abbott Laboratories, Chicago, USA) intramuscularly in the luteal phase of the previous cycle. The participants received 75-450 IU/d of either recombinant follicle-stimulating hormone (FSH) (Gonal-F; Serono, Munich, Germany) or highly purified human menopausal gonadotrophin (hMG) (Merional; IBSA, Lugno, Switzerland). The dosage was adjusted according to the serum E2 levels and vaginal ultrasound folliculometry. In the antagonist protocol group, 0.25 mg/d cetrorelix acetate (Cetrotide; Serono, Munich, Germany) was added on the day 5 of stimulation. When the sizes of three or more follicles became ≥16 mm, the patient was given 10,000 IU of chorionic gonadotrophin (Pregnyl; MERK, Hally, Germany) intramuscularly.

Oocyte Retrieval and Fertilization Transvaginal oocyte retrieval was scheduled 36 h after the administration of hCG and was performed under local anesthesia. Fertilization was achieved by intracytoplasmic sperm injection (ICSI). Pronuclear observation to determine fertilization was performed 16-18 h after insemination. A commercial sequential IVF medium (Cook, Eight Miles Plains, Queensland, Australia) was used for procedures involving the handling of gametes and embryos. All embryos were transferred on their respective day 3 post OPU.