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Is in vitro fertilisation more effective than stimulated intrauterine insemination as a first‐line therapy for subfertility? A cohort analysis
Author(s) -
CHAMBERS Georgina M.,
SULLIVAN Elizabeth A.,
SHANAHAN Marian,
HO Maria T.,
PRIESTER Katelyn,
CHAPMAN Michael G.
Publication year - 2010
Publication title -
australian and new zealand journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.734
H-Index - 65
eISSN - 1479-828X
pISSN - 0004-8666
DOI - 10.1111/j.1479-828x.2010.01155.x
Subject(s) - intrauterine insemination , in vitro fertilisation , fertilisation , medicine , cohort , andrology , gynecology , infertility , obstetrics , artificial insemination , cohort study , pregnancy , biology , reproductive technology , genetics , lactation
Objective: To compare a strategy of two cycles of intrauterine insemination with controlled ovarian hyperstimulation (IUI/COH) vs one in vitro fertilisation (IVF) treatment programme (one fresh plus associated frozen embryo cycles) in couples presenting with unexplained, mild male or mild female subfertility. Methods: A retrospective cohort design was used and analysed according to intention‐to‐treat principles. A total of 272 couples underwent an intended course of two cycles of IUI/COH and 176 couples underwent one IVF treatment programme. Results: The cumulative live birth rate (CLBR) per couple for the IUI/COH group was 27.6% compared to 39.2% for the IVF group ( P = 0.01). The mean time to pregnancy was 69 days in the IUI/COH group compared to 44 days in the IVF group ( P = 0.02). The IVF programme was costlier, with an incremental cost‐effectiveness ratio for an additional live birth in the range of $39 637–$46 325. The multiple delivery rate was 13.3% in the IUI/COH group compared to 10.1% in the IVF group ( P = 0.55). One set of triplets and one set of quadruplets followed IUI/COH treatment. Conclusions: One IVF treatment programme was more effective, but costlier than an intended course of two cycles of IUI/COH. With consistently higher success rates, shorter times to pregnancy and a trend to less higher order multiple pregnancies, this study supports the view that IVF is now potentially safer and more clinically effective than IUI/COH as a first‐line therapy for subfertility.