Clomifene citrate or unstimulated intrauterine insemination compared with expectant management for unexplained infertility: pragmatic randomised controlled trial

Bhattacharya, Siladitya; Harrild, Kirsten; Mollison, Jill; Wordsworth, Sarah; Tay, C.C.K.; Harrold, A; McQueen, Dana B.; Lyall, Helen; Johnston, Leanne M; Burrage, J; Grossett, S; Walton, H. J.; Lynch, J; Johnstone, Anne; Kini, Suresh; Raja, Aditya; Templeton, Allan

doi:10.1136/bmj.a716

Cited by 177 publications

(117 citation statements)

References 18 publications

(19 reference statements)

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“…In secondary infertility, it was observed that clinical pregnancy rates were 1.84-fold higher than in primary infertility. There are many studies in the literature supporting this data (20)(21)(22). However, contradictory conclusions have also been reported.…”

Section: Discussionmentioning

confidence: 77%

Factors affecting clinical pregnancy rates after IUI for the treatment of unexplained infertility and mild male subfertility

Atasever¹,

Kalem²,

Hatırnaz³

et al. 2016

J Turkish German Gynecol Assoc

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Objective:The aim of the present retrospective study was to evaluate intrauterine insemination (IUI) clinical experiences and to define the variables for predicting success. Material and Methods:The present study was an observational trial performed in a private IVF center on subfertile couples who had applied for treatment between 2002 and 2012, in which the data of 503 IUI cases were retrospectively reviewed. Couples who had been diagnosed with unexplained and mild male subfertility were included. The primary outcome measure was the clinical pregnancy rate in an attempt to form a predictive model for the odds of a clinical pregnancy. Recorded parameters were used to determine the prediction model. Results:Utilizing univariate logistic regression analysis, clinical pregnancy was positively associated with the duration of infertility (OR=1.09, p=0.089), secondary infertility (OR=1.77, p=0.050), and +4 sperm motility after preparation (OR=1.03, p=0.091). Following an adjustment analysis involving a multivariate logistic regression, clinical pregnancy was still found to positively associate with secondary infertility (OR=2.51, p=0.008). Conclusion:IUI success in secondary infertile couples who were in the unexplained infertility and mild male subfertility groups was higher than that in primary infertile couples, and the chances of pregnancy increased as sperm numbers with +4 motility increased. It is difficult to concomitantly evaluate all these parameters and to determine a predictive parameter in IUI independent from other factors. (J Turk Ger Gynecol Assoc 2016; 17: 134-8) Keywords: Intrauterine insemination, unexplained infertility, male subfertility Received: 1 April, 2016 Accepted: 25 July, 2016 Factors affecting clinical pregnancy rates after IUI for the treatment of unexplained infertility and mild male subfertility

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Section: Discussionmentioning

confidence: 77%

Factors affecting clinical pregnancy rates after IUI for the treatment of unexplained infertility and mild male subfertility

Atasever¹,

Kalem²,

Hatırnaz³

et al. 2016

J Turkish German Gynecol Assoc

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“…In 1998 Guzick et al performed a retrospective review of the literature of women receiving clomiphene citrate +/− intrauterine insemination (IUI), and found the pregnancy rate was 6-8 % per cycle, compared to 2-4 % when not treated [26]. On the contrary, a recent large prospective study which randomised 600 women with unexplained infertility to clomiphene citrate, IUI or expectant management showed comparable results for all three arms in terms of delivery rates [27]. However, the mean age of participants in these studies was 31-32 years and results of clomiphene citrate involving delivery rates for women aged 40 and above are rarely reported and are seldom prospective studies.…”

Section: Ovulation Induction With Clomiphene Citrate and Intrauterinementioning

confidence: 99%

What is the best treatment option for infertile women aged 40 and over?

Armstrong

Akande

2013

J Assist Reprod Genet

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Purpose To summarise the causes of decreased fecundity with age and review chronological vs biological ovarian ageing. To explore the clinician's means of assessing a woman's ovarian reserve. To review the recent literature on the effectiveness of different assisted reproductive technology (ART) techniques for women aged 40 and over and offer a single best treatment option. Methods Pubmed and google scholar were searched for relevant articles using key words. Data were extracted based on authors, year, aims, sample and results. Results Success rates for women aged 40 or over with clomiphene, IUI, IUI with FSH are all extremely low, at less than 1 % live birth per cycle. However, IVF offers a success rate of around 13.7 % per cycle. Conclusion An exploration of the effectiveness of available treatment options for older infertile women using their own gametes suggests that IVF offers the best prospects of success. Attempting treatments other than IVF will delay conception unnecessarily.

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“…Observation data suggest three fold increases in pregnancy rates with IUI alone, with further increase in concomitant ovarian stimulation. (Bhattacharya et al, 2008).…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Intra Uterine Insemination in the Treatment of Infertility

Yaaqoub¹

2011

American Medical Journal

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Problem statement:To assess efficacy of IUI in treatment of infertility. Tikrit teaching hospital. Approach: 42 infertile couple underwent standard evaluation for infertility, woman given medication to stimulate development of mature follicles, washed semen specimen placed in uterine cavity using sterile flexible catheter, coincide with ovulation time. Results: Of 42 infertile couples pregnancy occur in 26(61.9%), (19.1%) in primary and (42.9%) in secondary infertility, (21.3%) of them was male infertility and (40.6%) of unexplained infertility. Pregnancy was less with prolong duration of infertility (35.7%) with 3-5 years, (21.3%) with 5-7 years and (4.8%) with 8 and more years of infertility. Conclusion: IUI is less expensive, less invasive and effective in treatment of couples with unexplained or male infertility.

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Clomifene citrate or unstimulated intrauterine insemination compared with expectant management for unexplained infertility: pragmatic randomised controlled trial

Cited by 177 publications

References 18 publications

Factors affecting clinical pregnancy rates after IUI for the treatment of unexplained infertility and mild male subfertility

Factors affecting clinical pregnancy rates after IUI for the treatment of unexplained infertility and mild male subfertility

What is the best treatment option for infertile women aged 40 and over?

Efficacy of Intra Uterine Insemination in the Treatment of Infertility

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