Patients' preferences in deciding between intrauterine insemination and expectant management.
BACKGROUND
Intrauterine insemination (IUI) is a commonly used treatment in subfertile couples. We assessed patients' preferences for IUI relative to expectant management.


METHODS
Forty subfertile couples were offered scenarios in which the treatment-independent pregnancy chance was varied against a fixed pregnancy chance after IUI without or with controlled ovarian hyperstimulation (COH) of 8% and 12% per cycle, respectively. The treatment-independent pregnancy chance within 12 months was initially set at 100%, and subsequently reduced until couples switched preferences. We also investigated the impact of the risks of ovarian hyperstimulation syndrome (OHSS) and multiple pregnancy on couples' preferences.


RESULTS
When pregnancy was guaranteed within a year, all couples would opt for expectant management. Most couples switched to IUI without COH at a 60% chance of a treatment-independent pregnancy and to IUI with COH between a 40% and 60% chance. Where the risk of OHSS was set at 10%, a large majority of the couples preferred expectant management to IUI. At a multiple pregnancy risk of 100%, 77% of the couples would still prefer IUI.


CONCLUSIONS
The majority of couples prefer IUI with or without COH when the treatment-independent pregnancy chance in the next 12 months is <50% and <40%, respectively. The risk of a multiple pregnancy does not affect their preference for IUI, whereas IUI is rejected when the risk of OHSS exceeds 10%.
Steures
Pieternel
P
Department of Obstetrics & Gynaecology, Vrije Universiteit Medical Centre, Amsterdam, The Netherlands. pn.steures@amc.uva.nl
Berkhout
Jidske C
JC
Hompes
Peter G A
PG
van der Steeg
Jan Willem
JW
Bossuyt
Patrick M M
PM
van der Veen
Fulco
F
Habbema
J Dik F
JD
Eijkemans
Marinus J C
MJ
Mol
Ben W J
BW
D000328:Adult; D005260:Female; D006801:Humans; D007246:Infertility / Q000628:therapy*; D007317:Insemination, Artificial, Homologous; D008297:Male; D016471:Ovarian Hyperstimulation Syndrome / Q000209:etiology; D010062:Ovulation Induction / Q000009:adverse effects; D017060:Patient Satisfaction; D011247:Pregnancy; D011272:Pregnancy, Multiple; D018570:Risk Assessment; D013997:Time Factors