The effectiveness of intrauterine insemination: A matched cohort study.

Autor: Scholten I; Centre for Reproductive Medicine, Academic Medical Centre, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands., van Zijl M; Department of Obstetrics and Gynaecology, Catharina Ziekenhuis, Michelangelolaan 2, 5623 EJ Eindhoven, The Netherlands., Custers IM; Centre for Reproductive Medicine, Academic Medical Centre, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands., Brandes M; Department of Obstetrics and Gynaecology, Jeroen Bosch Ziekenhuis, Henri Dunantstraat 1, 5223 GZ, 's Hertogenbosch, The Netherlands., Gianotten J; Department of Obstetrics and Gynaecology, Kennemer Gasthuis, Boerhaavelaan 22 2035 RC Haarlem, The Netherlands., van der Linden PJQ; Department of Obstetrics and Gynaecology, Deventer Ziekenhuis, Nico Bolkesteinlaan 75, 7416 SE Deventer, The Netherlands., Hompes PGA; Centre for Reproductive Medicine, Vrije Universiteit Medical Centre, de Boelelaan 1117 1081 HZ Amsterdam, The Netherlands., van der Veen F; Centre for Reproductive Medicine, Academic Medical Centre, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands., Mol BWJ; Robinson Institute, School of Paediatrics and Reproductive Health, University of Adelaide, 5000 SA Australia. Electronic address: I.Scholten@amc.uva.nl.
Jazyk: angličtina
Zdroj: European journal of obstetrics, gynecology, and reproductive biology [Eur J Obstet Gynecol Reprod Biol] 2017 May; Vol. 212, pp. 91-95. Date of Electronic Publication: 2017 Mar 18.
DOI: 10.1016/j.ejogrb.2017.03.028
Abstrakt: Objective: To study the effectiveness of an intrauterine insemination (IUI) program compared to no treatment in subfertile couples with unexplained subfertility and a poor prognosis on natural conception.
Study Design: A retrospective matched cohort study in which ongoing pregnancy rates in 72 couples who voluntarily dropped out of treatment with IUI were compared to ongoing pregnancy rates in 144 couples who continued treatment with IUI. Couples with unexplained subfertility, mild male subfertility or cervical factor subfertility who started treatment with IUI between January 2000 and December 2008 were included. Couples were matched on hospital, age, duration of subfertility, primary or secondary subfertility and diagnosis. Primary outcome was cumulative ongoing pregnancy rate after three years. Time to pregnancy was censored at the moment couples were lost to follow up or when their child wish ended and, for the no-treatment group, when couples re-started treatment.
Results: After three years, there were 18 pregnancies in the stopped treatment group (25%) versus 41 pregnancies in the IUI group (28%) (RR 1.1 (0.59-2.2)(p=0.4)). The cumulative pregnancy rate after three years was 40% in both groups, showing no difference in time to ongoing pregnancy (shared frailty model p=0.86).
Conclusions: In couples with unexplained subfertility and a poor prognosis for natural conception, treatment with IUI does not to add to expectant management. There is need for a randomized clinical trial comparing IUI with expectant management in these couples.
(Copyright © 2017 Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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