Intrauterine insemination: how many cycles should we perform?
Authors: Custers, Inge M.; Steures, Pieternel; Hompes, Peter; Flierman, Paul; van Kasteren, Yvonne; van Dop, Peter A.; van der Veen, Fulco; Mol, Ben W.J.
Source: Human Reproduction, Volume 23, Number 4, 27 April 2008 , pp. 885-888(4)
Publisher: Oxford University Press
Abstract:BACKGROUNDIn the past 20 years, various recommendations have been made about the maximum number of intrauterine insemination (IUI) cycles that should be performed, because evidence underpinning a possible limit is lacking.METHODSWe performed a multicentre, retrospective cohort analysis among couples treated with IUI up to nine cycles. Primary outcome measure was ongoing pregnancy rate (OPR) per cycle. Cumulative OPRs (COPR) after three, six and nine cycles of IUI were calculated using life-table analysis. Univariable and multivariable logistic regression analysis was performed to identify variables possibly affecting OPR's.RESULTSOverall, 3714 couples with male, cervical or unexplained subfertility underwent 15 303 cycles of IUI. In 70 of cycles, controlled ovarian hyperstimulation (COH) was used (51 clomiphene-citrate, 19 gonadotropins). Mean OPR rate was 5.6 per cycle. OPR in the seventh, eighth and ninth cycle were 5.1, 6.7 and 4.6, respectively. Taking censored patients into account, the calculated COPR was 18 after the third cycle, 30 after the seventh cycle and 41 after the ninth cycle. If censored patients were considered to have no chance of conception, a crude COPR of 25 after nine cycles was found. Multivariable regression analysis showed no significant impact of age, type of subfertility, diagnosis, use of hyperstimulation or cycle number on OPR after the sixth treatment cycle.CONCLUSIONSOPR in high-order IUI cycles are acceptable, and do not offer a rationale for cancellation before nine cycles. Using this type of very mild COH, it may be reasonable to conduct up to nine cycles.
Document Type: Research article
Publication date: 2008-04-27
- Human Reproduction features full-length, peer-reviewed papers reporting original research, clinical case histories, as well as opinions and debates on topical issues. Papers published cover the scientific and medical aspects of reproductive physiology and pathology, endocrinology, andrology, gonad function, gametogenesis, fertilization, embryo development, implantation, pregnancy, genetics, genetic diagnosis, oncology, infectious disease, surgery, contraception, infertility treatment, psychology, ethics and social issues. The highest scientific and editorial standard is maintained throughout the journal along with a rapid rate of publication.