Intrauterine insemination with ovarian stimulation versus expectant management for unexplained infertility (TUI): a pragmatic, open-label, randomised, controlled, two-centre trial

Farquhar, Cynthia; Liu, Emily; Armstrong, Sarah; Arroll, Nicola; Lensen, Sarah; Brown, Julie

doi:10.1016/s0140-6736(17)32406-6

Cited by 96 publications

(74 citation statements)

References 27 publications

(50 reference statements)

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“…Our findings add context to the apparent discrepancies between the two randomised controlled trials that compared IUI-OS to expectant management (Steures et al, 2006;Farquhar et al, 2018). Steures et al included couples with an intermediate prognosis for natural conception i.e.…”

Section: Discussionmentioning

confidence: 61%

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Is IUI with ovarian stimulation effective in couples with unexplained subfertility?

et al. 2018

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Study question: Does starting intrauterine insemination with ovarian stimulation (IUI-OS) within one and a half years after completion of the fertility workup increase ongoing pregnancy rates compared to expectant management in couples with unexplained subfertility? Summary answer: IUI-OS is associated with higher chances of ongoing pregnancy compared to expectant management in unexplained subfertile couples, specifically those with poor prognoses of natural conception i.e. <15% over 6 months or <25% over one year. What is known already: IUI-OS is often the first-line treatment for couples with unexplained subfertility. Two randomised controlled trials compared IUI-OS to expectant management using different thresholds for the prognosis of natural conception as inclusion criteria and found conflicting results. A cohort of couples with unexplained subfertility exposed to 40% over one year) was 25% (95%CI: 21-28%) for expectant management and 24% (95%CI: 9-36%) when starting IUI-OS directly. For a couple with a prognosis of 15% (25% over one year), these predicted rates were 17% (95%CI: 15-19%) for expectant management and 24% (95%CI: 15-32%) for starting IUI-OS. Limitations, reasons for caution: The effect estimates are based on a prospective cohort followed up for one and a half years after completion of the fertility workup. Although we balanced the known predictors of conception between treated and untreated couples using inverse probability weighting, observational data may be subject to residual confounding. The results need to be confirmed in external datasets. Wider implications of the findings: These results explain the discrepancies between previous trials that compared IUI-OS to expectant management, but further studies are required to establish the threshold at which IUI-OS is (cost-)effective.

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Section: Discussionmentioning

confidence: 61%

“…In women with a poor prognosis i.e. <30% over 12 months, IUI-OS resulted in more live births than expectant management (Farquhar et al, 2018).…”

Section: Introductionmentioning

confidence: 97%

Is IUI with ovarian stimulation effective in couples with unexplained subfertility?

et al. 2018

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“…However, because there was still a chance of natural conception through expectant management in couples with unexplained infertility and a good prognosis, the 2013 guideline from the UK National Institute for Health and Care Excellence recommended extended expectant management instead of IUI-OI for these patients. More recently, a randomized, controlled, twocenter study in New Zealand in 2018 revealed that IUI-OI had a higher cumulative livebirth rate than three cycles of expectant management (31 vs. 9%; RR: 3.41, 95% CI: 1.71-6.79; p = 0.0003) in this particular population (12). Large multi-center trials comparing IUI in natural unstimulated cycles or stimulated cycles to extended expectant management were necessary to draw a firm conclusion.…”

Section: Discussionmentioning

confidence: 92%

The pregnancy outcomes of intrauterine insemination with husband's sperm in natural cycles versus ovulation stimulated cycles: A retrospective study

Ye¹,

Cao²,

Lin

et al. 2018

BST

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To compare the clinical outcomes of intrauterine insemination (IUI) with or without ovulation induction (OI), IUI cycles from January 2008 to December 2017 in Zhoushan Maternity and Child Healthcare Hospital were included, consisting of 455 natural cycles and 536 OI cycles. The overall clinical pregnancy rate did not differ between the two groups (P > 0.05). Stratified by OI medications such as clomiphene (CC), human menopausal gonadotropin (HMG) and follicle stimulating hormone (FSH), the pregnancy rates in HMG, CC, CC+HMG, and FSH/FSH+HMG groups were 11.70%, 13.58%, 15.95%, and 13.46%, respectively, but the difference was not significant compared with natural cycles (P > 0.05). Stratified by infertility etiology, the pregnancy rate was significantly higher in stimulated cycles than natural cycles with ovulation disorders (P < 0.01) and unexplained factors (P < 0.01) while it was significantly lower regarding cervical factors (P < 0.01), endometriosis (P < 0.05), male factor (P < 0.01) and other female factors. There was no strong difference of pregnancy rate for biparental causes (P > 0.05). Stratified by age category, women over 35 had higher pregnancy rate in stimulated cycles compared with natural cycles (18.75 vs. 12.24%; P < 0.05), while women under 35 had no significant difference of pregnancy rate between the two groups (13.65 vs 13.05%; P > 0.05). However, there was no significant difference between each ovarian stimulation group and natural cycle group regardless of the infertility causes or age categories. To conclude, IUI-OI could achieve a higher overall pregnancy rate for women over 35 and infertile patients with ovulation disorders and unexplained factors.

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“…The couples started with 6 months of ovarian stimulation (clomifene citrate/letrozole/metformin or a combination of the above) (Roque et al, 2015;Tatsumi et al, 2017) with the ultrasound monitoring during the cycles of treatment and timed sexual intercourse. All the couples who have not conceived within six cycles were qualified for 3-6 cycles of intrauterine insemination (IUI) (Farquhar et al, 2018) and in the end who have not conceived during IUI cycles to in vitro fertilization. Where investigations show there is no chance of pregnancy with expectant management and where in vitro fertilization is the only effective treatment, the woman was directly refereed to a specialist team for the in vitro treatment.…”

Section: Methodsmentioning

confidence: 99%

Supportive Social Interactions in Infertility Treatment Decrease Cortisol Levels: Experimental Study Report

2019

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Frontiers in Psychology | www.frontiersin.org December 2019 | Volume 10 | Article 2779 Malina et al. Supportive Social Interactions in Infertilityinteraction has a beneficial effect on infertile couple's health and well-being. The results of the study clearly point to the benefits of couples involved in infertility treatment to express and share their experience, and in doing so, provides measurable physiological and psychological benefits.

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Intrauterine insemination with ovarian stimulation versus expectant management for unexplained infertility (TUI): a pragmatic, open-label, randomised, controlled, two-centre trial

Cited by 96 publications

References 27 publications

Is IUI with ovarian stimulation effective in couples with unexplained subfertility?

Is IUI with ovarian stimulation effective in couples with unexplained subfertility?

The pregnancy outcomes of intrauterine insemination with husband's sperm in natural cycles versus ovulation stimulated cycles: A retrospective study

Supportive Social Interactions in Infertility Treatment Decrease Cortisol Levels: Experimental Study Report

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