Long term outcome in subfertile couples with isolated cervical factor

Area of Science:

• Reproductive Medicine
• Infertility Treatment
• Clinical Trials

Background:

• A prior randomized clinical trial (RCT) indicated higher immediate pregnancy rates with intrauterine insemination (IUI) versus expectant management for isolated cervical factors.
• The long-term effectiveness and cost-benefit of IUI in this population were previously unevaluated.

Purpose of the Study:

• To compare the long-term effectiveness of immediate intrauterine insemination (IUI) versus expectant management in subfertile couples with isolated cervical factors.
• To assess ongoing pregnancy rates three years post-randomization.

Main Methods:

• A follow-up study of 99 couples from a previous RCT.
• Couples were monitored for three years to register ongoing pregnancies and treatments.
• Primary outcome was ongoing pregnancy at three years.

Main Results:

• After three years, ongoing pregnancy rates were 71% in the immediate IUI group (36/51) and 79% in the expectant management group (38/48).
• The relative risk for ongoing pregnancy was 0.89 (95% CI 0.7-1.1), indicating no significant difference.
• No long-term benefit of immediate IUI was observed.

Conclusions:

• Immediate intrauterine insemination (IUI) does not lead to higher long-term ongoing pregnancy rates in couples with isolated cervical factors.
• Expectant management is a justified initial approach for these couples.
• Routine identification of cervical factors via post-coital testing may be unnecessary.