A technique commonly used as the first-line treatment for couples that have difficulty conceiving is not effective for those with a 30% chance of natural pregnancy, according to a study in this week's issue of The Lancet.
Couples that fail to conceive for unknown reasons after 1 year of unprotected sex may receive intrauterine insemination with controlled ovarian hyperstimulation to increase their chances of pregnancy. This technique has been reported to be more successful than intrauterine insemination without controlled ovarian hyperstimulation*, intracervical insemination, or timed intercourse. However, the treatment is costly and increases the risk of multiple births.
Pieternel Steures (Academic Medical Centre and Vrije Universiteit Medical Centre, Amsterdam, Netherlands) and colleagues assessed whether intrauterine insemination and ovarian hyperstimulation was more effective than expectant management**. The investigators randomly assigned 253 couples with unexplained subfertility and a 30-40% chance of spontaneous pregnancy to intrauterine insemination with ovarian hyperstimulation or expectant management for 6 months. In the treatment group, they found that 42 women conceived and 29 pregnancies were ongoing. In the expectant management group, 40 women conceived and 34 pregnancies were ongoing. The researchers conclude that there is no beneficial effect of intrauterine insemination with controlled ovarian hyperstimulation over expectant management in couples with more than a 30% chance of pregnancy. Expectant management for 6 months without any active treatment would be a better option for these couples, state the authors.
Mrs Steures states: "Our study shows that identification of couples who will not benefit from intrauterine insemination is possible. Through selection of these couples, the misuse of facilities and other resources can be avoided."
The authors add that intrauterine insemination without ovarian hyperstimulation- which is recommended by the UK's National Institute for Health and Clinical Excellence for unexplained subfertility – is "highly unlikely" to have a beneficial effect in couples with more than 30% chance of natural pregnancy.
*During ovarian hyperstimulation, a woman receives a hormone, which stimulates her ovaries and increases her chances of pregnancy.
**In the expectant management group couples were given advice on how to get pregnant naturally. These couples then tried to conceive naturally for 6 months.
Contact:
Mrs Pieternel Steures
Academic Medical Centre and Vrije Universiteit Medical Centre, Amsterdam, Netherlands.
T) 00 31 205 662 929
wetenschapsvoorlichting@amc.uva.nl
The Lancet