A randomised controlled trial of intra-uterine insemination versus<i>in vitro</i>fertilisation in patients with idiopathic or mild male infertility

Elzeiny, Hossam; Garrett, Claire; Toledo, Manuela G.; Stern, Kate; McBain, John; Baker, H. W. G.

doi:10.1111/ajo.12168

Cited by 18 publications

(13 citation statements)

References 21 publications

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“…130 Conversely, one small RCT demonstrated a benefit of IVF compared with expectant management in extensively pre-treated women, but the birth rate in the expectant management arm was very low 131 . IVF was more effective than unstimulated IUI 132,133 .…”

Section: [H1] Managementmentioning

confidence: 83%

Female subfertility

2019

Nat Rev Dis Primers

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Subfertility is common, and affects one in six couples, half of whom lack an explanation for their delay in conceiving. Developments in the diagnosis and treatment of subfertility over the past 50 years have been truly remarkable. Indeed, current generations of couples with subfertility are more fortunate than previous generations as they have many more opportunities to become parents. The timely access to effective treatment for subfertility is important, as many couples have a narrow window of opportunity before the age-related effects of subfertility limit the likelihood of success. Assisted reproduction can overcome the barriers to fertility caused by tubal disease and low sperm counts, but little progress has been made in reducing the effect of increasing age on ovarian function. The next 5-10 years will likely see further increases in birth rates in women with subfertility, greater awareness of lifestyle factors and possible refinement of current assisted reproduction techniques and development of new ones. Such progress will bring challenging questions regarding the potential benefits and harms of treatments involving germ-cell manipulation, artificial gametes, genetic screening of embryos, and gene editing of embryos. We hope to see a major increase in fertility awareness, access to safe and cost-effective fertility care in low-income countries, and a reduction in the current disparity of access to fertility care.

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Section: [H1] Managementmentioning

confidence: 83%

Female subfertility

2019

Nat Rev Dis Primers

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“…The exclusion criteria included (1) recurrent miscarriage; (2) ovarian tumors/cysts; (3) atypical endometrial hyperplasia; (4) cervical intraepithelial neoplasm (CIN) I-III; (5) chromosomal abnormalities; (6) intrauterine adhesion and (7) cycles with donor sperm. The detail of patient screening was showed in (Figure 1).…”

Section: Introductionmentioning

confidence: 99%

“…Elzeiny evaluated the effects of IVF and IUI in couples with unexplained infertility when only 2-3 mature follicles were stimulated by the same dosage of gonadotropin. Their study demonstrated that the IVF group had a greater live birth rate and lower cost per live birth ( 7 ).…”

Section: Introductionmentioning

confidence: 99%

The Livebirth Rate Per In Vitro Fertilization Cycle Is Higher Than The Cumulative Live Birth Rates of Intrauterine Insemination for Patients of Poseidon Group 3 With Unexplained Infertility

Liu

2021

Front. Endocrinol.

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BackgroundNo studies have been done to examine the efficacy of IVF and intrauterine insemination (IUI) for the treatment of young patients with unexplained infertility and low ovarian reserve, although it is becoming an increasingly significant indication for in-vitro fertilization (IVF). The goal of this research was to compare the efficacy of IVF with IUI on Poseidon group 3 patients with unexplained infertility (PG3&UI).MethodsThis was a retrospective analysis of PG3&UI patients who had IVF/intracytoplasmic sperm injection (ICSI) or IUI at the Third Affiliated Hospital of Guangzhou Medical University between January 1, 2015, and March 31, 2021. To equalize the baseline characteristics of the IVF/ICSI and IUI groups, propensity score matching (PSM) was utilized. Intention-to-treat (ITT) and per-protocol (PP) analyses were used to compare the differences in live births. To discover variations in time to biochemical pregnancy leading to live birth, Kaplan-Meier curves were produced. To evaluate the expenses per live birth between two procedures, a cost-effective analysis was done.ResultsAccording to ITT analysis, the live birth rate for the IVF/ICSI group was substantially higher than the cumulative live birth rate (CLBR) for the IUI group (22.6% (38/168) vs. 11.3% (19/168), RR 2.00, 95% CI 1.20-3.32, P = 0.006). In the PP analysis, the live birth rate was 23.0% (38/165) in the IVF/ICSI group and 11.7% (19/162) in the IUI group (RR = 1.96, 95% CI 1.18-3.26, P = 0.007). When censored at 365 days, the Kaplan-Meier analysis revealed that the IVF/ICSI group had a higher live birth rate than the IUI group (log-rank test χ²= 6.025; P = 0.014). However, when the two groups were censored at 180 days, the live birth rates were not substantially different (log-rank test χ²= 3.847; P = 0.05). The number of hospital visits per live birth in the IUI group was higher than in the IVF/ICSI group (85 vs. 48). The overall cost of a live birth was comparable across the two groups (¥132242 vs. ¥131611), while the medical expenses for a live delivery from IVF/ICSI were higher than those from IUI (¥118955 vs. ¥108279).ConclusionsThe livebirth rate per IVF/ICSI cycle with at most one embryo transfer is higher than the CLBR of IUI, with fewer hospital visits and similar expenses.

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“…The OR for multiple pregnancy was 0.50 (95% CI: 0.04-5.53) for IUI without COS compared to SI and 2.00 (95% CI: 0.18-22.34) for IUI with COS compared to SI. One RCT with 102 women offered same-dose FSH stimulation and who developed two or three follicles were randomised 3:1 to IUI (n=33) or IVF (n=10) (Elzeiny et al ., 2014). IUI or IVF was performed 36h after hCG administration with single or double embryo transfer on day two yielded clinical pregnancy rates (40% vs. 12%, p =0.04) and live birth rates (40% vs. 6%, p =0.01) favouring IVF over IUI.…”

Section: Introductionmentioning

confidence: 99%

Growing body of evidence supports intrauterine insemination as first line treatment and rejects unfounded concerns about its efficacy, risks and cost effectiveness

Bahadur

Homburg

2019

JBRA Assisted Reproduction

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IUI has been practiced for five decades but only three unconvincing trials attempted to demonstrate the superiority of IUI over sexual intercourse (SI). In the absence of evidence of its effectiveness, the National Institute for Clinical Excellence (NICE) recommended IVF over IUI after 2 years of unprotected SI. High-quality recent data in well-constructed studies suggest that biases against IUI procedures and in favour of IVF are invalid. It is unethical to continue to misinform patients and stakeholders. The well-constructed randomised controlled trials (RCT) show IUI procedure to be efficient, with minimal risk, and above all improved cost-effectiveness when compared to IVF for live birth. IUI as first-line treatment should be offered to most patients, while funding agencies and stakeholders need to be urgently informed of the cost-benefit in offering IUI. Fertility clinics, IVF interest groups, and regulatory bodies should amend their patient information and guidance to state that IUI should be the first line treatment and that IVF should be offered only when essential. Reappraising and promoting IUI based on evidence enhances patient autonomy, choices, and trust, while allowing the fertility industry to operate within an ethical and acceptable framework not seen as exploitative toward vulnerable patients.

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A randomised controlled trial of intra-uterine insemination versusin vitrofertilisation in patients with idiopathic or mild male infertility

Abstract: This study provides evidence that IVF is more successful and cost-effective than IUI using the same doses of FSH. Further confirmatory studies are required.

Cited by 18 publications

References 21 publications

Female subfertility

Female subfertility

The Livebirth Rate Per In Vitro Fertilization Cycle Is Higher Than The Cumulative Live Birth Rates of Intrauterine Insemination for Patients of Poseidon Group 3 With Unexplained Infertility

Growing body of evidence supports intrauterine insemination as first line treatment and rejects unfounded concerns about its efficacy, risks and cost effectiveness

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