title: In vitro fertilization versus conversion to intrauterine insemination in Bologna-criteria poor responders: how to decide which option?
abstract: OBJECTIVE
  To compare the continuation of in vitro fertilization (IVF) with the conversion to intrauterine insemination (IUI) in cases of suboptimal ovarian response in Bologna-criteria poor responders.
  
  
  METHODS
  Retrospective and multicenter comparative study.
  
  
  METHODS
  Three academic fertility centers and a fertility private clinic.
  
  
  METHODS
  Analysis of 7,176 initiated IVF cycles from January 2010 to January 2013. The 461 cycles with poor ovarian response (fewer than three follicles ≥16 mm at hCG trigger) in patients with poor response according to the Bologna criteria were included.
  
  
  METHODS
  Decision to pursue IVF (n = 184), convert to IUI (n = 141), or cancel cycle (n = 136) when only one or two follicles were recruited.
  
  
  METHODS
  Live birth, ultrasound pregnancy, and early pregnancy rates were compared depending on whether they resulted from IVF or IUI and were stratified according to patient age and the number of mature follicles at trigger.
  
  
  RESULTS
  Live birth rates were significantly higher for IVF patients compared with IUI conversion when two follicles were present (11.6% IVF vs. 1.6% IUI), especially for patients <40 years of age (13.1% IVF vs. 2% in IUI). In case of a monofollicular recruitment, the pregnancy outcomes were similar.
  
  
  CONCLUSIONS
  A therapeutic strategy could therefore be to pursue IVF for women demonstrating two follicles and to convert to IUI for cycles with only one follicle if the sperm and tubal parameters are favorable.
authors.affiliation: Department of Obstetrics and Gynecology, Fertility Center, Archet 2 University Hospital, Nice, France. Electronic address: m.quinquin@gmail.com.
authors.forename: Marine
authors.initials: M
authors.lastname: Quinquin
authors.affiliation: Matisse Center and St. George Clinic, Nice, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Mialon
authors.affiliation: Department of Obstetrics and Gynecology, Fertility Center, Archet 2 University Hospital, Nice, France.
authors.forename: Véronique
authors.initials: V
authors.lastname: Isnard
authors.affiliation: Department of Reproductive Medicine, Créteil Inter-Commune Hospital, Créteil, France.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Massin
authors.affiliation: Department of Obstetrics and Gynecology, Fertility Center, Paule de Viguier University Hospital, Toulouse, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Parinaud
authors.affiliation: Department of Obstetrics and Gynecology, Fertility Center, Archet 2 University Hospital, Nice, France.
authors.forename: Jérôme
authors.initials: J
authors.lastname: Delotte
authors.affiliation: Department of Obstetrics and Gynecology, Fertility Center, Archet 2 University Hospital, Nice, France.
authors.forename: André
authors.initials: A
authors.lastname: Bongain
mesh_terms: D000328:Adult; D001723:Birth Rate; D005260:Female; D005307:Fertilization in Vitro / Q000379:methods; D006801:Humans; D007315:Insemination, Artificial / Q000379:methods; D050498:Live Birth; D006080:Ovarian Follicle / Q000502:physiology*; D010062:Ovulation Induction; D011247:Pregnancy; D018873:Pregnancy Rate; D012189:Retrospective Studies
keywords: Bologna criteria; IUI; IVF; conversion; poor responders