Intrauterine insemination with gonadotropin stimulation or in vitro fertilization for the treatment of unexplained subfertility: a randomized controlled trial

Anupa Nandi, Priya Bhide, Richard Hooper, Anil Gudi, Amit Shah, Khalid S. Khan, Khalid Khan, Roy Homburg
Fertility and sterility · 2017 · vol. 107(6) , pp. 1329–1335.e2 · doi:10.1016/j.fertnstert.2017.03.028 · PMID:28501361 · W2612438784
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One cycle of IVF did not significantly differ in singleton live birth rate from three cycles of intrauterine insemination with gonadotropin stimulation for unexplained subfertility.

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Abstract

OBJECTIVE: To evaluate the best first line management option for the treatment of unexplained subfertility-controlled ovarian hyperstimulation (COH) with gonadotropins and IUI or IVF. DESIGN: Randomized controlled trial. SETTING: Single center trial in a tertiary referral unit. PATIENT(S): Couples with unexplained subfertility. INTERVENTION(S): Couples were randomized to receive either three cycles of IUI + COH or one cycle of IVF. MAIN OUTCOME MEASURE(S): Singleton pregnancy rate (PR) per couple. RESULT(S): A total of 207 couples were randomly assigned to three cycles of IUI + COH (n = 101) or one cycle of IVF (n = 106). There were 25 (24.7%) singleton live births for the IUI + COH group and 33 (31.1%) for the IVF group (relative risk, 1.3; 95% confidence interval [CI] 0.81-1.96) with an absolute risk difference of 6.4% (95% CI -5.8% to 18.6%). The multiple pregnancies per live birth were 4 (13.8%) for the IUI + COH group and 3 (8.3%) for the IVF group (relative risk, 0.6; 95% CI 0.14-2.4). There were no cases of ovarian hyperstimulation syndrome (OHSS) in the IUI group and three cases of OHSS (3.7%) in the IVF group. There were 17 live births from spontaneous conception in between treatment cycles (8.2%). CONCLUSION(S): The singleton live birth rate with one cycle of IVF was not significantly different than three cycles of IUI + COH. CLINICAL TRIAL REGISTRATION NUMBER: ISRCTN43430382.

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MeSH descriptors

Fertilization in Vitro Gonadotropins Infertility Insemination, Artificial Ovulation Induction Pregnancy Rate Adult Combined Modality Therapy Combined Modality Therapy Combined Modality Therapy Comorbidity Female Fertilization in Vitro Gonadotropins Humans Infertility Infertility Insemination, Artificial Male Ovarian Hyperstimulation Syndrome

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