Objective To assess maximal volume reduction of leiomyomas and uterus and the duration of treatment required to reach these reductions with daily GnRH antagonist treatment. Design Prospective, open-label study.Setting Large teaching hospital in The Netherlands.Population Premenopausal women with symptomatic fibroids, who were scheduled for surgery.Methods Twenty women were treated with daily 2 mg of subcutaneous ganirelix. Prior to the first injection and weekly during treatment, the volume of leiomyomas and the uterus were assessed by ultrasound (USS) and serum hormones were measured. Prior to treatment and when maximal size reduction was observed by USS, the volume of the leiomyomas and the uterus were also assessed by magnetic resonance imaging (MRI). Main outcome measures Leiomyoma and uterine size reduction, time to maximal reduction.Results One woman was excluded from the study due to incorrect administration dose of ganirelix. Data on the remaining 19 women (average age 39 years) with subserosal (n ¼ 9), submucosal (n ¼ 7), intramural (n ¼ 10) and transmural (n ¼ 1) leiomyomas were evaluated. Baseline leiomyoma volumes ranged from small (3 -4 mL) to large (>1000 mL). The median duration of treatment up to maximal leiomyoma size reduction was 19 days (range 1 -65 days). The maximal size reduction in leiomyomas measured by USS was À42.7% (À77.0% to 14.1%) and À29.2% (À62.2% to 35.6%) by MRI. Comparable uterine size reductions of À46.6% (À78.6% to À6.1%) and À25.2% (À63.6% to 28.9%) were observed by USS and MRI. During the first three weeks of treatment, 8 out of 19 women reported adverse events related to the induced hypoestrogenic state. Most of these events resolved within one week after treatment was discontinued. Conclusion Daily treatment with 2 mg of ganirelix results in rapid reduction of leiomyoma and uterine volume in premenopausal women with minor side effects. If longer-acting GnRH antagonists become available, pretreatment with GnRH antagonist should be preferred over GnRH agonists prior to surgery.

Objective To evaluate the effectiveness of 15 minutes of immobilisation versus immediate mobilisation after intrauterine insemination. Design Randomised controlled trial. Setting One academic teaching hospital and six nonacademic teaching hospitals. Participants Women having intrauterine insemination for unexplained, cervical factor, or male subfertility. Interventions 15 minutes of immobilisation or immediate mobilisation after insemination. Main outcome measure Ongoing pregnancy per couple. Results 391 couples were randomised; 199 couples were allocated to 15 minutes of immobilisation after intrauterine insemination, and 192 couples were allocated to immediate mobilisation (control). The ongoing pregnancy rate per couple was significantly higher in the immobilisation group than in the control group: 27% (n=54) versus 18% (34); relative risk 1.5, 95% confidence interval 1.1 to 2.2 (crude difference in ongoing pregnancy rates: 9.4%, 1.2% to 17%). Live birth rates were 27% (53) in the immobilisation group and 17% (32) in the control group: relative risk 1.6, 1.1 to 2.4 (crude difference for live birth rates: 10%, 1.8% to 18%). In the immobilisation group, the ongoing pregnancy rates in the first, second, and third treatment cycles were 10%, 10%, and 7%. The corresponding rates in the mobilisation group were 7%, 5%, and 5%.

OPR 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.

Patients' preferences for intrauterine insemination (IUI) relative to IVF were assessed using trade-off interviews, and the number of IUI cycles they would undergo before changing to IVF. A total of 73 couples undergoing IUI with a total of 111 interviews were included. Scenarios were offered where pregnancy chance after IUI was varied against a fixed pregnancy rate after IVF. The impact of multiple pregnancy risk on the couple's preference was also investigated. Interviews were held before starting IUI, after three or four IUI cycles and after six IUI cycles. With decreasing probability of ongoing pregnancy after IUI, an increasing number of couples switched their preference from IUI to IVF. This switch occurred after six cycles at a significantly higher (P = 0.01) mean cumulative pregnancy rate (53%) compared with other groups (31%). With increasing risk of multiple pregnancy, preference for IUI declined only slightly, with mean risks of 73, 78 and 83% of a multiple pregnancy for the three groups respectively. In conclusion, at baseline and after three cycles of IUI the majority of couples undergoing IUI preferred continuation of IUI over IVF. A clear shift in preference towards IVF occurred after six cycles. Risk of multiple pregnancy did not affect preference for IUI with ovarian stimulation.