The additional value of ovarian hyperstimulation in intrauterine insemination for couples with an abnormal postcoital test and a poor prognosis: a randomized clinical trial.

OBJECTIVE

To assess the effectiveness of controlled ovarian hyperstimulation (COH) in intrauterine insemination (IUI) for subfertile couples with an abnormal postcoital test and a poor prognosis.

DESIGN

Randomized clinical trial.

SETTING

Twenty-four fertility centers in the Netherlands.

PATIENT(S): Subfertile couples with a well-timed nonprogressive PCT and additional factors that reduce fertility.

INTERVENTION(S): Couples were randomly allocated to three cycles of IUI with COH or three cycles of IUI without COH.

MAIN OUTCOME MEASURE(S): Ongoing pregnancy within three IUI cycles.

RESULT(S): We randomly allocated 132 couples to IUI with COH, and 133, to IUI without COH. We observed 33 pregnancies (25%) in the couples allocated to IUI with COH, of which 28 were ongoing (21%), vs. 28 pregnancies (21%) in the couples allocated to IUI without COH, of which 23 were ongoing (17%; relative risk of an ongoing pregnancy, 1.2; 95% confidence interval, 0.75 to 2.0). Two multiple pregnancies occurred in the IUI with COH group, and one, in the IUI without COH group.

CONCLUSION(S): In couples with an abnormal PCT and a poor prognosis, IUI with COH leads to pregnancy rates comparable to those for IUI without COH. We propose to perform IUI without COH in couples with an abnormal PCT.