title: Couples with unexplained subfertility and unfavorable prognosis: a randomized pilot trial comparing the effectiveness of in vitro fertilization with elective single embryo transfer versus intrauterine insemination with controlled ovarian stimulation.
abstract: OBJECTIVE
  To evaluate the effectiveness of IVF with elective single embryo transfer (IVF-eSET) vs. IUI with controlled ovarian stimulation (IUI-COS) as an alternative treatment to reduce the risk for a multiple pregnancy.
  
  
  METHODS
  Randomized pilot trial.
  
  
  METHODS
  Three academic and six teaching hospitals in the Netherlands.
  
  
  METHODS
  Couples with unexplained or mild male subfertility and an unfavorable prognosis for natural conception.
  
  
  METHODS
  One cycle of IVF-eSET or three cycles of IUI-COS.
  
  
  METHODS
  Ongoing pregnancy per couple.
  
  
  RESULTS
  We randomly allocated 116 women to IVF-eSET (n = 58) or IUI-COH (n = 58). There were 14 ongoing pregnancies (24%) in the IVF-eSET group and 12 pregnancies (21%) in the IUI-COS group (relative ratio 1.17; 95% confidence interval 0.60-2.30). There were two twin pregnancies in the IVF-eSET group (14%) and two twin pregnancies and one triplet pregnancy in the IUI-COH group (25%).
  
  
  CONCLUSIONS
  In patients with unexplained or mild male subfertility and a poor prognosis for natural conception, one cycle of IVF-eSET might be as effective as three cycles of IUI-COS as primary treatment. Elective single embryo transfer does not seem an effective strategy in preventing multiple pregnancies in this particular population. In the future a strict SET policy (i.e., compulsory SET) might be an option. Our trial provides evidence for the feasibility and highlights the importance of a large definitive trial to determine the effectiveness and side effects of both strategies.
authors: Department of Obstetrics and Gynecology, Center for Reproductive Medicine, Academic Medical Center, Amsterdam, The Netherlands. i.m.custers@amc.uva.nl
authors: Inge M
authors: IM
authors: Custers
authors: Tamar E
authors: TE
authors: König
authors: Frank J
authors: FJ
authors: Broekmans
authors: Peter G A
authors: PG
authors: Hompes
authors: Eugenie
authors: E
authors: Kaaijk
authors: Jur
authors: J
authors: Oosterhuis
authors: Monique H
authors: MH
authors: Mochtar
authors: Sjoerd
authors: S
authors: Repping
authors: Madelon
authors: M
authors: van Wely
authors: Pieternel
authors: P
authors: Steures
authors: Fulco
authors: F
authors: van der Veen
authors: Ben W J
authors: BW
authors: Mol
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D005240:Feasibility Studies; D005260:Female; D005307:Fertilization in Vitro / Q000009:adverse effects; D006784:Hospitals, Teaching; D006801:Humans; D007246:Infertility / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D007315:Insemination, Artificial / Q000009:adverse effects; D053208:Kaplan-Meier Estimate; D008297:Male; D009426:Netherlands; D010062:Ovulation Induction / Q000009:adverse effects; D010865:Pilot Projects; D011247:Pregnancy; D018873:Pregnancy Rate; D059286:Pregnancy, Triplet; D059285:Pregnancy, Twin; D018570:Risk Assessment; D012307:Risk Factors; D056826:Single Embryo Transfer / Q000009:adverse effects; D016896:Treatment Outcome