Conversion from assisted reproductive technology to intrauterine insemination in low responders: is it advantageous?
OBJECTIVE
To examine cycle outcomes among patients demonstrating an attenuated ovarian response that proceeded to oocyte retrieval to those converted to intrauterine insemination (IUI).


METHODS
Retrospective cohort study.


METHODS
Large private fertility center.


METHODS
First planned autologous assisted reproductive technology (ART) cycles among women demonstrating a poor ovarian response to hyperstimulation (≤4 follicles≥14 mm, peak E2<1,000 IU/L at hCG administration).


METHODS
Oocyte retrieval or IUI conversion.


METHODS
Live birth and clinical pregnancy.


RESULTS
A total of 269 IUI conversions and 167 oocyte retrievals followed a poor ovarian response to gonadotropins among first planned ART cycles. Number of follicles≥14 mm (2.3 vs. 3.5) and peak E2 levels (555 vs. 743 pg/mL) were lower for IUI conversions compared with those proceeding to ART. Peak E2 was similar between groups after adjusting for follicle number (IUI: 611 pg/mL; ART: 652 pg/mL). Stimulation response was similar between treatment groups with equivalent follicle numbers. Undergoing oocyte retrieval was associated with significantly improved pregnancy (odds ratio [OR] 3.6, 95% confidence interval [CI] 1.8-7.4) and live birth outcome (OR 3.5, 95% CI 1.7-8.0) after adjusting for age and follicle number.


CONCLUSIONS
Among women demonstrating a poor ovarian response to gonadotropins, proceeding with planned ART resulted in significantly higher pregnancy rates than converting these cycles to IUI.
Norian
John M
JM
Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland 20892, USA. norianjo@mail.nih.gov
Levens
Eric D
ED
Richter
Kevin S
KS
Widra
Eric A
EA
Levy
Michael J
MJ
D000328:Adult; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007247:Infertility, Female / Q000628:therapy*; D007315:Insemination, Artificial / Q000706:statistics & numerical data; D010062:Ovulation Induction; D010360:Patient Transfer; D011247:Pregnancy; D018873:Pregnancy Rate; D027724:Reproductive Techniques, Assisted / Q000706:statistics & numerical data; D012189:Retrospective Studies; D017211:Treatment Failure; D028761:Withholding Treatment