I was reading about Clomid/IUI on UpToDate about this for a friend and came across the following info that basically states natural LH monitoring + IUI is more effective than hCG trigger + IUI in Clomid cycles.
However it seems to me that most centers -- including my med school and residency -- do use an hCG trigger! Why is this evidence being ignored?
What does your center do?
"For women undergoing CC ovarian stimulation, higher pregnancy rates have been reported when IUI is performed following spontaneous ovulation as documented by LH surge compared with IUI following hCG injection to trigger ovulation. In a meta-analysis of seven studies including over 2500 women, women who received IUI after hCG injection had a 25 percent reduction in clinical pregnancy rates compared with women who had IUI after LH surge (odds ratio, 0.74; 95% confidence interval, 0.57-0.96) [28]. Additionally, follicle monitoring with ultrasound and hCG triggering of ovulation increases the patient’s visit burden and cost, and therefore is rarely performed in place of CC therapy in our practice. We reserve ultrasound monitoring of the ovarian follicles for women in whom a serum LH is missed."
However it seems to me that most centers -- including my med school and residency -- do use an hCG trigger! Why is this evidence being ignored?
What does your center do?
"For women undergoing CC ovarian stimulation, higher pregnancy rates have been reported when IUI is performed following spontaneous ovulation as documented by LH surge compared with IUI following hCG injection to trigger ovulation. In a meta-analysis of seven studies including over 2500 women, women who received IUI after hCG injection had a 25 percent reduction in clinical pregnancy rates compared with women who had IUI after LH surge (odds ratio, 0.74; 95% confidence interval, 0.57-0.96) [28]. Additionally, follicle monitoring with ultrasound and hCG triggering of ovulation increases the patient’s visit burden and cost, and therefore is rarely performed in place of CC therapy in our practice. We reserve ultrasound monitoring of the ovarian follicles for women in whom a serum LH is missed."
