Intrauterine Insemination May Have Similar Outcomes as IVF

By Rob Goodier

January 22, 2015

NEW YORK (Reuters Health) - In select patients, intrauterine insemination (IUI) with ovarian hyperstimulation may offer similar rates of live birth and multiple pregnancies as the more invasive in vitro fertilization (IVF), a new trial has found.

The results suggest that physicians should not discount intrauterine insemination with controlled ovarian hyperstimulation as a first-line treatment of couples with unexplained or mild male subfertility, Madelon van Wely, a clinical epidemiologist at the University of Amsterdam's Center for Reproductive Medicine in the Netherlands, who led the study, and her colleagues wrote in a research paper published online January 9 in the BMJ.

"IVF is thought to be more successful than IUI, both by doctors and patients. The success of the first IVF treatment cycle is indeed higher, but when combining multiple cycles then IUI does equally well," van Wely told Reuters Health by email. "It seems couples need to have more patience."

The researchers performed a noninferiority trial of 602 couples in the Netherlands, comparing intrauterine insemination to two types of IVF: IVF with a single embryo transfer and IVF in a modified natural cycle.

They found healthy birth rates of 52% for IVF with single embryo transfer, 47% for intrauterine insemination, and 43% for IVF in a modified natural cycle.

And they found multiple pregnancy rates of 5% for IVF in a modified natural cycle, 6% for IVF with a single embryo transfer and 7% for intrauterine insemination.

The differences did not approach significance and the researchers deemed the three procedures non-inferior in those outcomes.

The paper highlights the important message that IVF is not the only option for infertile couples, Dr. Adam Fechner, of the Department of Obstetrics, Gynecology, and Women's Health, Rutgers-New Jersey Medical School, who was not involved in the research, told Reuters Health by email.

"IVF is a very powerful tool that has revolutionized our field and, in some cases such as severe male factor infertility or tubal disease, may in fact be the only way for a couple to conceive. But for a variety of reasons, whether cost or religion or simply personal preference, many patients cannot or do not want to do IVF, at least not until all other options have been exhausted," Dr. Fechner said.

This study may support an argument for a balanced approach to treatment, Dr. Fechner said.

This research was funded by ZonMW, the Dutch Organization for Health Research, and Development and Zorgverzekeraars Nederland, the Dutch association of healthcare insurers. The authors report no disclosures. SOURCE: https://bmj.co/159CR4q BMJ 2015.

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