A multi-center prospective, randomized, double-blind trial studying the effect of misoprostol on the outcome of intrauterine insemination.
BACKGROUND
Because seminal prostaglandins play a role at natural fertilization, it was hypothesized that vaginal supplementation of prostaglandins at the time of intrauterine insemination (IUI) might enhance chances of conception. We investigated the effect of misoprostol, a prostaglandin analogue, on the success rate of IUI.


METHODS
A multi-center double-blind randomized controlled trial, using a cross-over design with alternating sequence, was designed. Vaginal tablets of misoprostol or placebo were used in conjunction to intrauterine insemination. In total, 199 women, comprising 466 cycles, were analyzed. Main outcome measures were pregnancy rate and prevalence of vaginal bleeding and uterine cramps.


RESULTS
The misoprostol group accounted for 146 cycles with 19 pregnancies, whereas the placebo group cycles totaled 164 cycles with 21 pregnancies (13.0 vs. 12.8%, not significant). There was a statistically significant increase in vaginal bleeding (12.3 vs. 1.8%; OR 7.55; 95% CI 2.31-24.48) and abdominal cramping rates (15.1 vs. 4.3%; OR 3.98; 95% CI 1.68-9.39) after application of misoprostol. Due to these severe adverse events the study was prematurely terminated.


CONCLUSIONS
Although prostaglandins surely play a role in natural human reproduction, vaginal administration of misoprostol at the time of IUI is associated with a high rate of side effects and does not seem to enhance the outcome.
Billiet
Kelly
K
Department of Obstetrics and Gynaecology, Ghent University Hospital, Ghent, Belgium.
Dhont
Marc
M
Vervaet
Chris
C
Vermeire
An
A
Gerris
Jan
J
De Neubourg
Diane
D
Delbeke
Luc
L
Ombelet
Willem
W
De Sutter
Petra
P
D015746:Abdominal Pain / Q000139:chemically induced; D000282:Administration, Intravaginal; D000328:Adult; D018592:Cross-Over Studies; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007315:Insemination, Artificial / Q000379:methods*; D008297:Male; D016595:Misoprostol / Q000008:administration & dosage* / Q000009:adverse effects; D011247:Pregnancy; D011446:Prospective Studies; D011465:Prostaglandins, Synthetic / Q000008:administration & dosage* / Q000009:adverse effects; D014592:Uterine Hemorrhage / Q000139:chemically induced; D055815:Young Adult
D011465:Prostaglandins, Synthetic; D016595:Misoprostol