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Hum. Reprod. Advance Access published online on January 7, 2005
Human Reproduction, doi:10.1093/humrep/deh673
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Human Reproduction © European Society of Human Reproduction and Embryology 2005; all rights reserved
Received September 30, 2004
Accepted November 19, 2004

Article

Patients' preferences in deciding between intrauterine insemination and expectant management

Pieternel Steures 1*, Jidske C. Berkhout 2, Peter G.A. Hompes 3, Jan Willem van der Steeg 1, Patrick M.M. Bossuyt 4, Fulco van der Veen 2, J. Dik F. Habbema 5, Marinus J.C. Eijkemans 5, and Ben W.J. Mol 6

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 Centre for Reproductive Medicine, Academic Medical Centre, Amsterdam, The Netherlands
3 Department of Obstetrics & Gynaecology, Vrije Universiteit Medical Centre, Amsterdam, The Netherlands
4 Department of Biostatistics & Epidemiology, Academic Medical Centre, Amsterdam, The Netherlands
5 Department of Public Health, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
6 Centre for Reproductive Medicine, Academic Medical Centre, Amsterdam, The Netherlands; Department of Obstetrics & Gynaecology, Maximá Medical Centre, Veldhoven, The Netherlands

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


  Abstract

BACKGROUND: Intrauterine insemination (IUI) is a commonly used treatment in subfertile couples. We assessed patients' preferences for IUI relative to expectant management. METHODS: Forty subfertile couples were offered scenarios in which the treatment-independent pregnancy chance was varied against a fixed pregnancy chance after IUI without or with controlled ovarian hyperstimulation (COH) of 8% and 12% per cycle, respectively. The treatment-independent pregnancy chance within 12 months was initially set at 100%, and subsequently reduced until couples switched preferences. We also investigated the impact of the risks of ovarian hyperstimulation syndrome (OHSS) and multiple pregnancy on couples' preferences. RESULTS: When pregnancy was guaranteed within a year, all couples would opt for expectant management. Most couples switched to IUI without COH at a 60% chance of a treatment-independent pregnancy and to IUI with COH between a 40% and 60% chance. Where the risk of OHSS was set at 10%, a large majority of the couples preferred expectant management to IUI. At a multiple pregnancy risk of 100%, 77% of the couples would still prefer IUI. CONCLUSIONS: The majority of couples prefer IUI with or without COH when the treatment-independent pregnancy chance in the next 12 months is <50% and <40%, respectively. The risk of a multiple pregnancy does not affect their preference for IUI, whereas IUI is rejected when the risk of OHSS exceeds 10%.

Keywords: intrauterine insemination; preference; subfertility.
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