Couples with unexplained subfertility and unfavorable prognosis: a randomized pilot trial comparing the effectiveness of in vitro fertilization with elective single embryo transfer versus intrauterine insemination with controlled ovarian stimulation

Custers, Inge M.; König, T.E.; Broekmans, Frank J.; Hompes, Peter G.A.; Kaaijk, Eugenie M.; Oosterhuis, Jur; Mochtar, Monique H.; Repping, Sjoerd; Wely, Madelon van; Steures, Pieternel; Veen, Fulco van der; Mol, Ben Willem J.

doi:10.1016/j.fertnstert.2011.08.005

Cited by 47 publications

(44 citation statements)

References 14 publications

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“…In 2011, Custers et al randomised 116 couples with unexplained and mild male factor subfertility and unfavourable prognosis of natural conception, to one cycle of IVF‐eSET (elective single embryo transfer) and three cycles of IUI plus COH. They found similar live birth rates: 24% in the IVF‐eSET group and 21% in the IUI plus COH group (relative ratio 1.17; 95% CI 0.60–2.30).…”

Section: Treatment Options For Unexplained Subfertilitymentioning

confidence: 99%

“…77 The same group compared two cycles of clomiphene citrate and IUI versus two cycles of FSH and IUI versus immediate IVF in 154 couples with older women (38-42 years) and demonstrated superior pregnancy rates and fewer treatment cycles with immediate IVF. 87 In 2011, Custers et al 88 randomised 116 couples with unexplained and mild male factor subfertility and unfavourable prognosis of natural conception, to one cycle of IVF-eSET (elective single embryo transfer) and three cycles of IUI plus COH. They found similar live birth rates: 24% in the IVF-eSET group and 21% in the IUI plus COH group (relative ratio 1.17; 95% CI 0.60-2.30).…”

Section: In Vitro Fertilisationmentioning

confidence: 99%

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Unexplained subfertility: diagnosis and management

Nandi

Homburg

2016

The Obstetric & Gynaecologis

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Key content Unexplained subfertility is diagnosed when standard investigations (tests for ovulation, tubal patency and semen analysis) are all normal. Between 30% and 40% of subfertile couples fall into this category. In some couples, unexplained subfertility may result from subtle undetectable factors; in other couples, it may be associated with a genuine absence of any abnormality. There is currently much controversy about the selection of appropriate management options for such couples, especially following the National Institute for Health and Care Excellence (NICE) guideline published in 2013. Therefore, a clear understanding of the available evidence is essential for the management of couples with unexplained subfertility. The potential contributing factors, diagnosis and management of unexplained subfertility are discussed. Learning objectives To summarise the available recent evidence and help the reader obtain a clear understanding of the continuing debates in this field. To help clinicians in counselling couples with unexplained subfertility. Ethical issues Should couples be advised to try to conceive naturally for 2 years (regardless of their age) before they are offered treatment, even though fecundity declines with age? What does the evidence suggest should be the first line of management for couples with unexplained subfertility: intrauterine insemination or in vitro fertilisation?

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Section: Treatment Options For Unexplained Subfertilitymentioning

confidence: 99%

Section: In Vitro Fertilisationmentioning

confidence: 99%

Unexplained subfertility: diagnosis and management

Nandi

Homburg

2016

The Obstetric & Gynaecologis

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“…Similarly, Custers et al . reported a 25% multiple pregnancy rate with OS/IUI, including a triplet pregnancy that resulted from four follicles triggered with hCG . Thus, while a higher pregnancy rate may have been achieved with IUI in our trial had subjects with higher follicle numbers been randomised, it is likely the multiple pregnancy rate would have been unacceptable.…”

Section: Discussionmentioning

confidence: 70%

“…This high IVF pregnancy rate is in line with our results and recent general improvement in IVF results. In contrast, Custers et al . compared cumulative ongoing pregnancy rates from IVF with ovarian stimulation to achieve at least three follicles and transfer of one or two embryos fresh or cryopreserved to up to three IUI treatments with FSH stimulation and up to three follicles.…”

Section: Discussionmentioning

confidence: 99%

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

Elzeiny

Garrett

Toledo

et al. 2014

Aust N Z J Obstet Gynaecol

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“…For the comparison of IVF with IUI + ovarian stimulation, three RCT were available for inclusion in a Cochrane review (Pandian et al, 2012). Two small studies (Custers et al, 2011;Goverde et al, 2000) in treatment-naive women showed 37 live births in 117 IVF cycles as compared with 34 live births in 117 IUI plus ovarian stimulation cycles (difference not significant). In clomiphene-pretreated women, Reindollar and coworkers (2010) showed 100 live births after 172 IVF cycles and 37 live births after 169 IUI + ovarian stimulation cycles, resulting in a significant difference.…”

Section: What About Assisted Reproduction Treatment?mentioning

confidence: 99%

The wobbly evidence base of reproductive medicine

Evers

2013

Reproductive BioMedicine Online

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In assisted reproduction, there is strong evidence for some things done, but no or only very weak evidence for others. There are several reasons for this. Most assisted reproduction procedures have small signal-to-noise ratios. This means that their treatment effect is sometimes only little better than the spontaneous conception rate, or the conception rate with traditional treatment. Hence, large trials are required. These demand complex multicentre logistics. The latter require substantial funding and funding for reproductive medicine in most countries is notoriously difficult to obtain (as opposed, for example, to oncology research or cardiovascular research). Apart from these funding issues, the creation of embryos specifically for research is only allowed in a limited number of European countries, thus tempting clinicians to skip preclinical studies altogether and go directly for clinical application in their patients, raising an ethical issue. Introducing new treatments into the clinic without proper evidence, however, is perhaps even more of an ethical issue. Subfertile couples are very vulnerable and should not be exploited.

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Couples with unexplained subfertility and unfavorable prognosis: a randomized pilot trial comparing the effectiveness of in vitro fertilization with elective single embryo transfer versus intrauterine insemination with controlled ovarian stimulation

Cited by 47 publications

References 14 publications

Unexplained subfertility: diagnosis and management

Unexplained subfertility: diagnosis and management

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

The wobbly evidence base of reproductive medicine

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