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Hum. Reprod. Advance Access published online on August 27, 2004
Human Reproduction, doi:10.1093/humrep/deh435
© 2004 by European Society of Human Reproduction and Embryology
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Received March 29, 2004
Accepted July 2, 2004

Article

Does ovarian hyperstimulation in intrauterine insemination for cervical factor subfertility improve pregnancy rates?

Pieternel Steures 1*, Jan Willem van der Steeg 1, Harold R. Verhoeve 2, Peter A. van Dop 3, Peter G.A. Hompes 4, Patrick M.M. Bossuyt 5, Fulco van der Veen 6, J.Dik F. Habbema 7, Marinus J.C. Eijkemans 7, Ben W.J. Mol 8

1 Department of Obstetrics & Gynaecology, Vrije Universiteit Medical Centre, Amsterdam, The Netherlands; Centre for Reproductive Medicine, Academic Medical Centre, Amsterdam, The Netherlands; Department of Public Health, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
2 Department of Obstetrics & Gynaecology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
3 Department of Obstetrics & Gynaecology, Catharina-Ziekenhuis, Eindhoven, The Netherlands
4 Department of Obstetrics & Gynaecology, Vrije Universiteit Medical Centre, Amsterdam, The Netherlands
5 Department of Clinical Epidemiology and Biostatistics, Academic Medical Centre, Amsterdam, The Netherlands
6 Centre for Reproductive Medicine, Academic Medical Centre, Amsterdam, The Netherlands
7 Department of Public Health, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
8 Centre for Reproductive Medicine, Academic Medical Centre, Amsterdam, The Netherlands; Department of Obstetrics & Gynaecology, Máxima Medical Centre, Veldhoven, The Netherlands

* To whom correspondence should be addressed. E-mail: pn.steures{at}amc.uva.nl.


  Abstract

BACKGROUND: Intrauterine insemination (IUI) can be performed with or without controlled ovarian hyperstimulation (COH). Studies in which the additional benefit of COH on IUI for cervical factor subfertility is assessed are lacking. We assessed whether COH in IUI improved pregnancy rates in cervical factor subfertility. METHODS: We performed a historical cohort study among couples with cervical factor subfertility, treated with IUI. A cervical factor was diagnosed by a well-timed, non-progressive post-coital test with normal semen parameters. We compared ongoing pregnancy rate per cycle in groups treated with IUI with or without COH. We tabulated ongoing pregnancy rates per cycle number and compared the effectiveness of COH by stratified univariable analysis. RESULTS: We included 181 couples who underwent 330 cycles without COH and 417 cycles with COH. Ongoing pregnancy rates in IUI cycles without and with COH were 9.7% and 12.7%, respectively (odds ratio 1.4; 95% confidence interval 0.85-2.2). The pregnancy rates in IUI without COH in cycles 1, 2, 3 and 4 were 14%, 11%, 6% and 15%, respectively. For IUI with COH, these rates were 17%, 15%, 14% and 16%, respectively. CONCLUSIONS: Although our data indicate that COH improves the pregnancy rate over IUI without COH, IUI without COH generates acceptable pregnancy rates in couples with cervical factor subfertility. Since IUI without COH bears no increased risk for multiple pregnancy, this treatment should be seriously considered in couples with cervical factor subfertility.

Keywords: cervical factor; controlled ovarian hyperstimulation; intrauterine insemination; ongoing pregnancy; subfertility.
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