title: The additional value of ovarian hyperstimulation in intrauterine insemination for couples with an abnormal postcoital test and a poor prognosis: a randomized clinical trial.
abstract: OBJECTIVE
  To assess the effectiveness of controlled ovarian hyperstimulation (COH) in intrauterine insemination (IUI) for subfertile couples with an abnormal postcoital test and a poor prognosis.
  
  
  METHODS
  Randomized clinical trial.
  
  
  METHODS
  Twenty-four fertility centers in the Netherlands.
  
  
  METHODS
  Subfertile couples with a well-timed nonprogressive PCT and additional factors that reduce fertility.
  
  
  METHODS
  Couples were randomly allocated to three cycles of IUI with COH or three cycles of IUI without COH.
  
  
  METHODS
  Ongoing pregnancy within three IUI cycles.
  
  
  RESULTS
  We randomly allocated 132 couples to IUI with COH, and 133, to IUI without COH. We observed 33 pregnancies (25%) in the couples allocated to IUI with COH, of which 28 were ongoing (21%), vs. 28 pregnancies (21%) in the couples allocated to IUI without COH, of which 23 were ongoing (17%; relative risk of an ongoing pregnancy, 1.2; 95% confidence interval, 0.75 to 2.0). Two multiple pregnancies occurred in the IUI with COH group, and one, in the IUI without COH group.
  
  
  CONCLUSIONS
  In couples with an abnormal PCT and a poor prognosis, IUI with COH leads to pregnancy rates comparable to those for IUI without COH. We propose to perform IUI without COH in couples with an abnormal PCT.
authors.affiliation: Department of Obstetrics and Gynecology, Vrije Universiteit Medical Center, 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: Peter G A
authors.initials: PG
authors.lastname: Hompes
authors.forename: Patrick M M
authors.initials: PM
authors.lastname: Bossuyt
authors.forename: J Dik F
authors.initials: JD
authors.lastname: Habbema
authors.forename: Marinus J C
authors.initials: MJ
authors.lastname: Eijkemans
authors.forename: Caroline A M
authors.initials: CA
authors.lastname: Koks
authors.forename: Petra
authors.initials: P
authors.lastname: Boudrez
authors.forename: Fulco
authors.initials: F
authors.lastname: van der Veen
authors.forename: Ben W J
authors.initials: BW
authors.lastname: Mol
mesh_terms: D000022:Abortion, Spontaneous / Q000209:etiology; D000328:Adult; D003075:Coitus; D003944:Diagnostic Techniques, Obstetrical and Gynecological; D005191:Family Characteristics; D005260:Female; D006801:Humans; D007246:Infertility / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D007317:Insemination, Artificial, Homologous; D008297:Male; D010062:Ovulation Induction / Q000379:methods*; D011247:Pregnancy; D018873:Pregnancy Rate; D011379:Prognosis; D013997:Time Factors