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Is in vitro fertilisation more effective than stimulated intrauterine insemination as a first-line therapy for subfertility? A cohort analysis

Authors

  • Georgina M. CHAMBERS,

    1. Perinatal and Reproductive Epidemiology Research Unit, School Women’s and Children’s Health, University of New South Wales, Randwick, New South Wales, Australia
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  • Elizabeth A. SULLIVAN,

    1. Perinatal and Reproductive Epidemiology Research Unit, School Women’s and Children’s Health, University of New South Wales, Randwick, New South Wales, Australia
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  • Marian SHANAHAN,

    1. National Drug and Alcohol Research Centre, University of New South Wales, Randwick,, New South Wales, Australia
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  • Maria T. HO,

    1. Office of Medical Education, Sydney Medical School, University of Sydney, Camperdown, New South Wales, Australia
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  • Katelyn PRIESTER,

    1. Perinatal and Reproductive Epidemiology Research Unit, School Women’s and Children’s Health, University of New South Wales, Randwick, New South Wales, Australia
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  • Michael G. CHAPMAN

    1. Perinatal and Reproductive Epidemiology Research Unit, School Women’s and Children’s Health, University of New South Wales, Randwick, New South Wales, Australia
    2. Discipline of Obstetrics and Gynaecology, School Women’s and Children’s Health, University of New South Wales, Royal Hospital for Women, Randwick, New South Wales, Australia
    3. IVFAustralia Pty Ltd Southern Sydney, St George Private Hospital, Kogarah, New South Wales, Australia
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Dr Georgina M. Chambers, Perinatal and Reproductive Epidemiology Research Unit, School Women’s and Children’s Health, University of New South Wales, Level 2 McNevin Dickson Building, Randwick Hospitals Campus, Randwick, NSW 2031, Australia. Email: g.chambers@unsw.edu.auDr Georgina M. Chambers, A/Prof Elizabeth A. Sullivan, Ms Marian Shanahan, A/Prof Maria Theresa Ho, and Ms Katelyn Priester do not declare any commercial or other conflict of interest.Prof Chapman is a shareholder in IVFAustralia.

Abstract

Objective:  To compare a strategy of two cycles of intrauterine insemination with controlled ovarian hyperstimulation (IUI/COH) vs one in vitro fertilisation (IVF) treatment programme (one fresh plus associated frozen embryo cycles) in couples presenting with unexplained, mild male or mild female subfertility.

Methods:  A retrospective cohort design was used and analysed according to intention-to-treat principles. A total of 272 couples underwent an intended course of two cycles of IUI/COH and 176 couples underwent one IVF treatment programme.

Results:  The cumulative live birth rate (CLBR) per couple for the IUI/COH group was 27.6% compared to 39.2% for the IVF group (= 0.01). The mean time to pregnancy was 69 days in the IUI/COH group compared to 44 days in the IVF group (= 0.02). The IVF programme was costlier, with an incremental cost-effectiveness ratio for an additional live birth in the range of $39 637–$46 325. The multiple delivery rate was 13.3% in the IUI/COH group compared to 10.1% in the IVF group (= 0.55). One set of triplets and one set of quadruplets followed IUI/COH treatment.

Conclusions:  One IVF treatment programme was more effective, but costlier than an intended course of two cycles of IUI/COH. With consistently higher success rates, shorter times to pregnancy and a trend to less higher order multiple pregnancies, this study supports the view that IVF is now potentially safer and more clinically effective than IUI/COH as a first-line therapy for subfertility.

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