Direct intraperitoneal insemination compared to intrauterine insemination in superovulated cycles: a randomized cross-over study.

The aim of this randomized cross-over study was to determine whether direct intraperitoneal insemination (DIPI) is superior to intrauterine insemination (IUI) in hyperstimulated cycles. The treatment cycles were stimulated with either clomiphene citrate and human menopausal gonadotrophins, or buserelin and human menopausal gonadotrophins. 207 subfertile couples with a cervical factor, a male factor, a combined cervical and male factor, or an unexplained subfertility were randomly assigned to the first treatment cycle. IUI and DIPI were performed in alternate cycles to a maximum of 6 cycles per couple. Every treatment cycle was followed by a nontreatment cycle. The pregnancy rate per completed cycle was 24% for IUI and 16% for DIPI (p = 0.018), whereas the cumulative pregnancy rates for IUI and DIPI were 53 and 40%, respectively (p = 0.002). There were no significant differences between pregnancy rates for IUI and DIPI in the different categories of subfertility. We conclude that DIPI does not offer better pregnancy chances than IUI in superovulated cycles.