Intrauterine Insemination or In-VitroFertilisation in Idiopathic Subfertility and Male Subfertility A Randomised Trial and Cost-Effectiveness Analysis

Couples who are subfertile for unknown reasons or because of male factors spontaneously conceive at an estimated rate of about 2 percent per cycle. Counseling of these couples has proved difficult because of a paucity of high-quality comparative studies. This prospective, randomized trial randomly assigned 258 couples with idiopathic or male subfertility to receive a maximum of six cycles of intrauterine insemination (IUI) in the spontaneous cycle, IUI after mild ovarian hyperstimulation, or in vitrofertilization (IVF). The primary end point was pregnancy resulting in a live birth. The couples had had idiopathic subfertility for at least 3 years or male subfertility for 1 year or longer. IUI alone was performed 20 to 30 hours after the endogenous LH surge was detected. Mild hyperstimulation was produced using a low dose of FSH. IVF utilized controlled ovarian hyperstimulation by a gonadotropin-releasing hormone agonist and human menopausal gonadotropin or FSH. Brief stimulation was used in women older than 38 years.