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About Controlled Ovarian Hyperstimulation/Artificial Insemination (COH/AIH)
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IUI |
What is COH/AIH?
This approach consists of ovarian stimulation using fertility drugs and artificial insemination with husband's semen. To stimulate the development of ovarian follicles, injections of FSH (either alone or with LH) are used. When the leading follicle is mature, an injection of hCG is administered which results in the release of the egg(s) 36-48 hours later. At that time, insemination is performed with washed and processed husband's semen. Sperm is injected into the uterus (intrauterine insemination - IUI) or into the fallopian tube on the side of ovulation (intratubal insemination - ITI). The choice between IUI and ITI depends on the number of sperm in the specimen. The objective is to provide an adequate number of normal sperm in the fallopian tube where fertilization takes place.
What are the benefits?
COH/AIH can correct several infertility problems such as anovulation, ovulatory dysfunction, hormonal dysfunction, oligospermia, asthenospermia, or teratospermia. This approach will help in the development of a healthy ovarian follicle which will produce adequate estrogen levels to prepare the reproductive system for pregnancy. It will facilitate release of the egg from the ovary and will assure an adequate number of sperm in the reproductive system.
What are the requirements?
To be effective, COH/AIH requires at least one patent and normally functioning fallopian tube, a normal uterus, and normal eggs and sperm. If there is evidence of abnormal tubal function, abnormal gamete function, or of diseases such as endometriosis, COH/AIH may be ineffective and IVF/ET may have to be selected as the initial approach.
What are the results?
Fecundity rate per cycle (chance for pregnancy) with COH/AIH is less than the normal age-dependent cycle fecundity of 15-20% because many couples with unrecognized fertility problems not correctable by COH/AIH are typically included in the treatment. This is primarily so because, as mentioned earlier, there are no tests for tubal function, fertilizing potential of the gametes, or quality of embryonic development. A cumulative 3-4 cycle fecundity rate with COH/AIH is about 30-40% and there is little, if any, increase in pregnancy rates after the third or fourth cycle. If there is no pregnancy after 3-4 cycles of COH/AIH, the couple should proceed to IVF/ET.
What are the risks and complications?
The major disadvantage of COH/AIH is the risk of multiple pregnancy because more than one egg can be released at the time. To prevent this complication, careful ultrasound examinations to determine the number of ovarian follicles and an on-site laboratory capable of rapid hormone determinations are mandatory. High-order multiple pregnancies (publicized by the media) have been conceived exclusively during the COH/AIH cycles. Ovarian hyperstimulation syndrome (OHSS) is another potential complication. When several follicles develop at the same time, the ovary increases in size which may cause pelvic pain, peritoneal irritation, and fluid and electrolyte imbalance. In extreme circumstances, the patient may have to be hospitalized. OHSS is also preventable through careful sonographic and hormonal monitoring.
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Approach One - (COH/AIH) Approach Two - (IVF/ET) 
Symptoms/Diagnosis Management of Infertility Management of Chronic Pelvic Pain 
SUCCESS RATE 
Dr. Dmowski Dr. Rana Dr. Ding Nurses Facilities Accrediation / Affiliations 
