Is IUI with ovarian stimulation effective in couples with unexplained subfertility?
R van Eekelen1,2, N van Geloven3, M van Wely1
1Centre for Reproductive Medicine, Academic Medical Centre, Meibergdreef 9, AZ Amsterdam, the Netherlands.
Human Reproduction (Oxford, England)
|November 6, 2018
Summary
Intrauterine insemination with ovarian stimulation (IUI-OS) increases ongoing pregnancy rates compared to expectant management for unexplained subfertility. This benefit is most pronounced in couples with a poor prognosis for natural conception.
Area of Science:
- Reproductive Medicine
- Infertility Treatment
- Subfertility Management
Background:
- Unexplained subfertility affects numerous couples, with Intrauterine Insemination with Ovarian Stimulation (IUI-OS) often being a first-line treatment.
- Previous trials comparing IUI-OS to expectant management yielded conflicting results due to differing inclusion criteria regarding natural conception prognosis.
- A prospective cohort study was designed to evaluate the efficacy of IUI-OS versus expectant management in couples with unexplained subfertility.
Purpose of the Study:
- To determine if initiating IUI-OS within 1.5 years of fertility workup increases ongoing pregnancy rates compared to expectant management.
- To assess if the effectiveness of IUI-OS is influenced by a couple's prognosis for natural conception.
Main Methods:
- A prospective cohort study involving couples with unexplained or mild male subfertility was conducted across seven Dutch centers.
- Follow-up was truncated at 1.5 years post-fertility workup, with ongoing pregnancy as the primary endpoint.
- A sequential Cox approach and inverse probability weighting were used to compare pregnancy rates and correct for conception predictors.
Main Results:
- The study included 1896 couples, with 800 undergoing IUI-OS and 1096 managed expectantly.
- Starting IUI-OS was associated with a significantly higher chance of ongoing pregnancy (hazard ratio: 1.96) compared to expectant management.
- The treatment effect was more pronounced in couples with poorer prognoses for natural conception, indicating personalized treatment benefits.
Conclusions:
- IUI-OS demonstrates higher ongoing pregnancy rates than expectant management for unexplained subfertile couples, particularly those with poor natural conception prognoses.
- The findings help reconcile previous conflicting trial results and highlight the importance of individual prognosis in treatment decisions.
- Further research is needed to establish the cost-effectiveness thresholds for implementing IUI-OS.
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