Intrauterine insemination in natural cycle may give better results in older women

Original Paper

Abstract

Background: Controlled ovarian hyper-stimulation (COH) in combination with intrauterine insemination (IUI) has been shown to result in significantly higher pregnancy rates compared to un-stimulated (natural cycle) IUI [1]. This may however not be true in all ages.

Methods: We performed a retrospective cohort study and analysed data collected prospectively on 1759 IUI cycles in couples with unexplained infertility. The results were analysed to show the outcome of IUI with COH, and IUI in natural cycle (unstimulated), in younger women compared to their older counterparts.

Results: In women age 37 and younger, COH resulted in a significantly higher pregnancy rate (13.0% vs 6.5%) and live-birth rate (10.7% vs 5.2%) compared to natural cycle IUI (p = 0.025, p = 0.045 respectively). However for older women age >37 years, natural cycle (unstimulated) IUI, resulted in a significantly higher pregnancy rate (12.0% vs 8.5%) live-birth rate (7.5%vs 3.5%) than IUI with COH ((p = 0.0037). This difference is even more significant when COH was performed with clomiphene citrate (7.5% vs 2.1%) (p = 0.0017).

Conclusion: COH was associated with a lower live birth rate in older women, irrespective of the agent used, and it seems to be worse when the anti-oestrogenic drug clomiphene citrate was used for COH. Older women may benefit more from natural cycle (unstimulated) IUI. A randomised controlled trial is required to confirm this observation.

Keywords

Intrauterine insemination Controlled ovarian hyper-stimulation Natural cycle Infertility 

References

  1. 1.
    Guzick DS, Carson SA, Coutifaris C, Overstreet JW, Factor-Litvak P, Steinkampf MP, Hill JA, Mastroianni L, Buster JE, Nakajima ST, Vogel DL, Canfield RE. Efficacy of superovulation and intrauterine insemination in the treatment of infertility. N Engl J Med 1999;340:177–83PubMedCrossRefGoogle Scholar
  2. 2.
    Cohlen BJ, Vandekerdkhove P, te Velde ER, Habbema JDF. Timed intercourse versus intrauterine insemination with or without ovarian hyperstimulation for subfertility in men. Cochrane Database Sys Rev 2000; (2):CD000360Google Scholar
  3. 3.
    NICE (National Institute for Clinical Excellence). Fertility: Assessment and treatment for people with fertility problems. Clinical guidelines published by RCOG press. RCOG, 2004:75–80Google Scholar
  4. 4.
    Paterson CM, Hatasaka HH, Jones KP, Poulson AM, Carrell DT. Ovulation induction with gonadotropins and intrauterine insemination compared with invitro-fertilisation and no therapy: A prospective, non-randomised, cohort study and meta-analysis. Fertil Steril 1994;62:535–44Google Scholar
  5. 5.
    Steures P, Van Der Steeg JW, Verhoeve HR, Van Dop PA, Hompes PGA, Bossuyt PMM, Van Der Veen F, Habbema JDF, Eijkemans MJC, Mol BWJ. Does ovarian hyperstimulation in intrauterine insemination for cervical factor subfertility improve pregnancy rates? Hum Reprod 2006;19:2263–6CrossRefGoogle Scholar
  6. 6.
    Attaullah N, Proctor M, Johnson NP. Oral versus injectable ovulation induction agents for unexplained subfertility. Cochrane Database of Sys Rev 2002; (3):CD003052Google Scholar
  7. 7.
    Birkenfeld A, Beier HM, Schenker JG. The effect of clomiphene citrate on early embryonic development, endometrium and implantation. Hum Reprod, 1986;1:387–93PubMedGoogle Scholar
  8. 8.
    Laufer N, Prat BM, DeCherny AH, et al. The in-vivo and in-vitro effects of clomiphene citrate on ovulation, fertilisation and development of cultured mouse oocytes. Am J Obstet Gynecol. 1983;147:633PubMedGoogle Scholar
  9. 9.
    Rogers PA, Polson D, Murphy CR et al., Correlation of endometrial histology, morphometry, and ultrasound appearance after different stimulation protocols for in-vitro fertilisation. Fertil Steril 1991;55:583–7PubMedGoogle Scholar
  10. 10.
    Gleicher N, Oleske DM, Tur-kaspa I, Vidali A, Karande V. Reducing the risk of higher order multiple pregnancy after ovarian stimulation with gonadotropins. N Engl J Med. 2000;1(343):2–7CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  1. 1.Lister Fertility ClinicLister HospitalLondonUK
  2. 2.Chelsea and Westminster HospitalLondonUK

Personalised recommendations