For unexplained infertility-IUI with drugs or IVF, which is best?

Conventional treatment for couples experiencing unexplained infertility has usually consisted of three cycles of clomiphene (CC) with IUI, followed by three cycles of gonadotropins (FSH) with IUI and then IVF if those conservative measures did not work.

A study in the August 2010 issue of Fertility & Sterility looks at the time it took to establish a pregnancy that led to a live birth and cost-effectiveness of either conventional treatment with three cycles of clomiphene citrate CC/IUI, three cycles of gonadotropins FSH/IUI, and up to six cycles of IVF or an accelerated treatment that omitted the three cycles of FSH/IUI.

An increased rate of pregnancy was observed in the accelerated arm compared with the conventional arm. Median time to pregnancy was 8 and 11 months in the accelerated and conventional arms, respectively. Per cycle pregnancy rates for CC/IUI, FSH/IUI, and IVF were 7.6%, 9.8%, and 30.7%, respectively. Average charges per delivery were lower in the accelerated arm compared to conventional treatment. The observed incremental difference was a savings of $2,624 per couple for accelerated treatment.

In my experience many couples are bypassing the option of FSH/IUI, not only because of the increased time and expense to success, but also because IVF provides more control over high-order multiple pregnancies as we transfer fewer embryos.

Arthur L. Wisot, M. D.

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