title: Is in vitro fertilisation more effective than stimulated intrauterine insemination as a first-line therapy for subfertility? A cohort analysis.
abstract: OBJECTIVE
  To compare a strategy of two cycles of intrauterine insemination with controlled ovarian hyperstimulation (IUI/COH) vs one in vitro fertilisation (IVF) treatment programme (one fresh plus associated frozen embryo cycles) in couples presenting with unexplained, mild male or mild female subfertility.
  
  
  METHODS
  A retrospective cohort design was used and analysed according to intention-to-treat principles. A total of 272 couples underwent an intended course of two cycles of IUI/COH and 176 couples underwent one IVF treatment programme.
  
  
  RESULTS
  The cumulative live birth rate (CLBR) per couple for the IUI/COH group was 27.6% compared to 39.2% for the IVF group (P = 0.01). The mean time to pregnancy was 69 days in the IUI/COH group compared to 44 days in the IVF group (P = 0.02). The IVF programme was costlier, with an incremental cost-effectiveness ratio for an additional live birth in the range of $39,637-$46,325. The multiple delivery rate was 13.3% in the IUI/COH group compared to 10.1% in the IVF group (P = 0.55). One set of triplets and one set of quadruplets followed IUI/COH treatment.
  
  
  CONCLUSIONS
  One IVF treatment programme was more effective, but costlier than an intended course of two cycles of IUI/COH. With consistently higher success rates, shorter times to pregnancy and a trend to less higher order multiple pregnancies, this study supports the view that IVF is now potentially safer and more clinically effective than IUI/COH as a first-line therapy for subfertility.
authors.affiliation: Perinatal and Reproductive Epidemiology Research Unit, School Women's and Children's Health, University of New South Wales, Randwick, New South Wales, Australia. g.chambers@unsw.edu.au
authors.forename: Georgina M
authors.initials: GM
authors.lastname: Chambers
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Sullivan
authors.forename: Marian
authors.initials: M
authors.lastname: Shanahan
authors.forename: Maria T
authors.initials: MT
authors.lastname: Ho
authors.forename: Katelyn
authors.initials: K
authors.lastname: Priester
authors.forename: Michael G
authors.initials: MG
authors.lastname: Chapman
mesh_terms: D000328:Adult; D001723:Birth Rate; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D005260:Female; D005307:Fertilization in Vitro / Q000191:economics; D006801:Humans; D007246:Infertility / Q000628:therapy*; D007315:Insemination, Artificial / Q000191:economics; D008297:Male; D010062:Ovulation Induction / Q000191:economics; D011247:Pregnancy; D012189:Retrospective Studies