Long term outcome in subfertile couples with isolated cervical factor

Abstract Objective A previous randomized clinical trial (RCT) compared immediate treatment with intrauterine insemination (IUI) to expectant management for six months in subfertile couples with an isolated cervical factor. That study showed higher ongoing pregnancy rates in couples receiving intraut...

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Bibliographic Details
Published in:European journal of obstetrics & gynecology and reproductive biology 2013-10, Vol.170 (2), p.429-433
Main Authors: Scholten, Irma, Moolenaar, Lobke M, Gianotten, Judith, van der Veen, Fulco, Hompes, Peter G.A, Mol, Ben W.J, Steures, Pieternel
Format: Article
Language:English
Subjects:
Adult
Cervical factor
Cost-effectiveness
Expectant management
Female
Follow-Up Studies
Humans
Infertility - therapy
Insemination, Artificial, Homologous - economics
Insemination, Artificial, Homologous - statistics & numerical data
Intrauterine insemination
Male
Obstetrics and Gynecology
Pregnancy
Pregnancy Rate
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Summary:Abstract Objective A previous randomized clinical trial (RCT) compared immediate treatment with intrauterine insemination (IUI) to expectant management for six months in subfertile couples with an isolated cervical factor. That study showed higher ongoing pregnancy rates in couples receiving intrauterine insemination. The current study compared the long-term effectiveness and costs of this intervention. Study design We followed all couples ( N = 99) who were previously included in the RCT for three years after randomization and registered pregnancies and treatments. After the initial trial period, couples in both groups were offered further treatment according to local protocol. The primary outcome was an ongoing pregnancy after three years. Results After three years, there were 36 ongoing pregnancies in the immediate IUI group ( N = 51 couples) and 38 ongoing pregnancies in the expectant management group ( N = 48 couples). The ongoing pregnancy rates were 71% and 79% respectively (RR 0.89 (95% confidence interval (CI) 0.7–1.1)). Conclusions In couples with an isolated cervical factor, a treatment strategy including immediate treatment with IUI does not result in higher ongoing pregnancy rates on the long term. Initial expectant management is therefore justified in these couples and identifying a cervical factor by a post-coital test is unnecessary.
ISSN:0301-2115
1872-7654
DOI:10.1016/j.ejogrb.2013.06.042