Controlled ovarian hyperstimulation and intrauterine insemination for treating male subfertility: a controlled study

Abstract

In this randomized crossover trial we investigated whether the use of controlled ovarian hyperstimulation with low-dose human menopausal gonadotrophin in couples with male subfertility leads to a higher probability of conception when intrauterine insemination (IUI) is applied. We also investigated whether the efficacy of IUI in natural or stimulated cycles was related to the severity of male subfertility. Seventy-four couples completed 308 treatment cycles. Thirteen pregnancies occurred after IUI in a natural cycle (pregnancy rate per completed cycle: 8.4%) and 21 after IUI in a stimulated cycle (pregnancy rate per completed cycle: 13.7%). The difference between the two treatment modalities was not statistically significant. The efficacy of IUI in stimulated cycles was related to the severity of the semen defect. In couples with a total motile sperm count < 10 x 10(6), ovarian stimulation did not improve treatment outcome, while it did in couples with a total motile sperm count > or = 10 x 10(6). Compared with the expected chance of conceiving spontaneously without treatment, both natural and stimulated cycles improved the probability of conception. We conclude that, for the group as a whole, ovarian stimulation did not improve the probability of conception. However, in couples with less severe semen defects, ovarian stimulation did improve the probability of conception.

Evaluation of female prognostic factors influencing pregnancy rate after intrauterine insemination with controlled ovarian hyper stimulation in infertile couples in a tertiary care hospital

“…6 Intrauterine insemination is defined as direct transfer of motile spermatozoa into the uterine cavity after semen preparation and concentration in a small volume of medium. 7 The pregnancy rate (PR) after intra uterine insemination has varied between 9 and 21% per cycle.…”

A Comparison of Within-Subjects and Between-Subjects Designs in Studies with Discrete-Time Survival Outcomes

“…In the introduction, an example of a CO design with right-censored survival outcomes is given by a study investigating the effect of using controlled ovarian hyper-stimulation on the probability of conception via intrauterine insemination (IUI) [13]. A total of 74 couples with male sub-fertility are randomized to IUI in a natural cycle or to IUI in a cycle with ovarian stimulation.…”

“…An example of a crossover design with discrete-time survival endpoints is a fertility study was conducted to study the effect of ovarian stimulation on increasing the chance of conception [13]. The outcome was timing of pregnancy that was recorded discretely after each treatment cycle.…”

Should We Continue Performing Intrauterine Inseminations in the Year 2004?

“…Thus, in case of a male factor, MOH does not seem to improve the probability of conception. The study performed by Cohlen et al [13] differentiates between couples with a severe or moderate male factor (total motile sperm count on average ! 10 !…”

“…Several randomized trials on MOH/IUI have been published using low-dose step-up protocols, with intensive monitoring and strict cancellation criteria [13,15,17,[26][27][28] . Table 10 shows a comparison of stimulation protocols, cancellation criteria, and outcome of these trials.…”