title: Does ovarian hyperstimulation in intrauterine insemination for cervical factor subfertility improve pregnancy rates?
abstract: BACKGROUND
  Intrauterine insemination (IUI) can be performed with or without controlled ovarian hyperstimulation (COH). Studies in which the additional benefit of COH on IUI for cervical factor subfertility is assessed are lacking. We assessed whether COH in IUI improved pregnancy rates in cervical factor subfertility.
  
  
  METHODS
  We performed a historical cohort study among couples with cervical factor subfertility, treated with IUI. A cervical factor was diagnosed by a well-timed, non-progressive post-coital test with normal semen parameters. We compared ongoing pregnancy rate per cycle in groups treated with IUI with or without COH. We tabulated ongoing pregnancy rates per cycle number and compared the effectiveness of COH by stratified univariable analysis.
  
  
  RESULTS
  We included 181 couples who underwent 330 cycles without COH and 417 cycles with COH. Ongoing pregnancy rates in IUI cycles without and with COH were 9.7% and 12.7%, respectively (odds ratio 1.4; 95% confidence interval 0.85-2.2). The pregnancy rates in IUI without COH in cycles 1, 2, 3 and 4 were 14%, 11%, 6% and 15%, respectively. For IUI with COH, these rates were 17%, 15%, 14% and 16%, respectively.
  
  
  CONCLUSIONS
  Although our data indicate that COH improves the pregnancy rate over IUI without COH, IUI without COH generates acceptable pregnancy rates in couples with cervical factor subfertility. Since IUI without COH bears no increased risk for multiple pregnancy, this treatment should be seriously considered in couples with cervical factor subfertility.
authors.affiliation: Department of Obstetrics & Gynaecology, Vrije Universiteit Medical Centre, Amsterdam, The Netherlands. pn.steures@amc.uva.nl
authors.forename: Pieternel
authors.initials: P
authors.lastname: Steures
authors.forename: Jan Willem
authors.initials: JW
authors.lastname: van der Steeg
authors.forename: Harold R
authors.initials: HR
authors.lastname: Verhoeve
authors.forename: Peter A
authors.initials: PA
authors.lastname: van Dop
authors.forename: Peter G A
authors.initials: PG
authors.lastname: Hompes
authors.forename: Patrick M M
authors.initials: PM
authors.lastname: Bossuyt
authors.forename: Fulco
authors.initials: F
authors.lastname: van der Veen
authors.forename: J Dik F
authors.initials: JD
authors.lastname: Habbema
authors.forename: Marinus J C
authors.initials: MJ
authors.lastname: Eijkemans
authors.forename: Ben W J
authors.initials: BW
authors.lastname: Mol
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007247:Infertility, Female / Q000209:etiology* / Q000628:therapy*; D007317:Insemination, Artificial, Homologous; D016017:Odds Ratio; D010062:Ovulation Induction; D011247:Pregnancy; D018873:Pregnancy Rate; D012189:Retrospective Studies; D016896:Treatment Outcome; D002577:Uterine Cervical Diseases / Q000150:complications*