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

Chambers, GM; Sullivan, EA; Shanahan, M; Ho, MT; Priester, K; Chapman, MG

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

Chambers, GM Sullivan, EA

Shanahan, M Ho, MT Priester, K Chapman, MG

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Publication Type:: Journal Article
Citation:: Australian and New Zealand Journal of Obstetrics and Gynaecology, 2010, 50 (3), pp. 280 - 288
Issue Date:: 2010-01-01

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Field	Value	Language
dc.contributor.author	Chambers, GM	en_US
dc.contributor.author	Sullivan, EA https://orcid.org/0000-0002-8718-2753	en_US
dc.contributor.author	Shanahan, M	en_US
dc.contributor.author	Ho, MT	en_US
dc.contributor.author	Priester, K	en_US
dc.contributor.author	Chapman, MG	en_US
dc.date.issued	2010-01-01	en_US
dc.identifier.citation	Australian and New Zealand Journal of Obstetrics and Gynaecology, 2010, 50 (3), pp. 280 - 288	en_US
dc.identifier.issn	0004-8666	en_US
dc.identifier.uri	http://hdl.handle.net/10453/28499
dc.description.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 (P = 0.01). The mean time to pregnancy was 69 days in the IUI/COH group compared to 44 days in the IVF group (P = 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 (P = 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. © 2010 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.	en_US
dc.relation.ispartof	Australian and New Zealand Journal of Obstetrics and Gynaecology	en_US
dc.relation.isbasedon	10.1111/j.1479-828X.2010.01155.x	en_US
dc.subject.classification	Obstetrics & Reproductive Medicine	en_US
dc.subject.mesh	Humans	en_US
dc.subject.mesh	Infertility	en_US
dc.subject.mesh	Insemination, Artificial	en_US
dc.subject.mesh	Fertilization in Vitro	en_US
dc.subject.mesh	Ovulation Induction	en_US
dc.subject.mesh	Birth Rate	en_US
dc.subject.mesh	Retrospective Studies	en_US
dc.subject.mesh	Cohort Studies	en_US
dc.subject.mesh	Pregnancy	en_US
dc.subject.mesh	Adult	en_US
dc.subject.mesh	Cost-Benefit Analysis	en_US
dc.subject.mesh	Female	en_US
dc.subject.mesh	Male	en_US
dc.title	Is in vitro fertilisation more effective than stimulated intrauterine insemination as a first-line therapy for subfertility? A cohort analysis	en_US
dc.type	Journal Article
utslib.citation.volume	3	en_US
utslib.citation.volume	50	en_US
utslib.for	1114 Paediatrics and Reproductive Medicine	en_US
utslib.for	1117 Public Health and Health Services	en_US
pubs.embargo.period	Not known	en_US
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
pubs.organisational-group	/University of Technology Sydney/Faculty of Health/Public Health
utslib.copyright.status	closed_access
pubs.issue	3	en_US
pubs.publication-status	Published	en_US
pubs.volume	50	en_US

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 (P = 0.01). The mean time to pregnancy was 69 days in the IUI/COH group compared to 44 days in the IVF group (P = 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 (P = 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. © 2010 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

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http://hdl.handle.net/10453/28499