title: The effectiveness of intrauterine insemination: A matched cohort study.
abstract: OBJECTIVE
  To study the effectiveness of an intrauterine insemination (IUI) program compared to no treatment in subfertile couples with unexplained subfertility and a poor prognosis on natural conception.
  
  
  METHODS
  A retrospective matched cohort study in which ongoing pregnancy rates in 72 couples who voluntarily dropped out of treatment with IUI were compared to ongoing pregnancy rates in 144 couples who continued treatment with IUI. Couples with unexplained subfertility, mild male subfertility or cervical factor subfertility who started treatment with IUI between January 2000 and December 2008 were included. Couples were matched on hospital, age, duration of subfertility, primary or secondary subfertility and diagnosis. Primary outcome was cumulative ongoing pregnancy rate after three years. Time to pregnancy was censored at the moment couples were lost to follow up or when their child wish ended and, for the no-treatment group, when couples re-started treatment.
  
  
  RESULTS
  After three years, there were 18 pregnancies in the stopped treatment group (25%) versus 41 pregnancies in the IUI group (28%) (RR 1.1 (0.59-2.2)(p=0.4)). The cumulative pregnancy rate after three years was 40% in both groups, showing no difference in time to ongoing pregnancy (shared frailty model p=0.86).
  
  
  CONCLUSIONS
  In couples with unexplained subfertility and a poor prognosis for natural conception, treatment with IUI does not to add to expectant management. There is need for a randomized clinical trial comparing IUI with expectant management in these couples.
authors.affiliation: Centre for Reproductive Medicine, Academic Medical Centre, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
authors.forename: Irma
authors.initials: I
authors.lastname: Scholten
authors.affiliation: Department of Obstetrics and Gynaecology, Catharina Ziekenhuis, Michelangelolaan 2, 5623 EJ Eindhoven, The Netherlands.
authors.forename: Maud
authors.initials: M
authors.lastname: van Zijl
authors.affiliation: Centre for Reproductive Medicine, Academic Medical Centre, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
authors.forename: Inge M
authors.initials: IM
authors.lastname: Custers
authors.affiliation: Department of Obstetrics and Gynaecology, Jeroen Bosch Ziekenhuis, Henri Dunantstraat 1, 5223 GZ, 's Hertogenbosch, The Netherlands.
authors.forename: Monique
authors.initials: M
authors.lastname: Brandes
authors.affiliation: Department of Obstetrics and Gynaecology, Kennemer Gasthuis, Boerhaavelaan 22 2035 RC Haarlem, The Netherlands.
authors.forename: Judith
authors.initials: J
authors.lastname: Gianotten
authors.affiliation: Department of Obstetrics and Gynaecology, Deventer Ziekenhuis, Nico Bolkesteinlaan 75, 7416 SE Deventer, The Netherlands.
authors.forename: Paul J Q
authors.initials: PJQ
authors.lastname: van der Linden
authors.affiliation: Centre for Reproductive Medicine, Vrije Universiteit Medical Centre, de Boelelaan 1117 1081 HZ Amsterdam, The Netherlands.
authors.forename: Peter G A
authors.initials: PGA
authors.lastname: Hompes
authors.affiliation: Centre for Reproductive Medicine, Academic Medical Centre, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
authors.forename: Fulco
authors.initials: F
authors.lastname: van der Veen
authors.affiliation: Robinson Institute, School of Paediatrics and Reproductive Health, University of Adelaide, 5000 SA Australia. Electronic address: I.Scholten@amc.uva.nl.
authors.forename: Ben W J
authors.initials: BWJ
authors.lastname: Mol
mesh_terms: D000328:Adult; D005260:Female; D005307:Fertilization in Vitro / Q000706:statistics & numerical data*; D006801:Humans; D007246:Infertility / Q000628:therapy*; D007315:Insemination, Artificial / Q000379:methods / Q000706:statistics & numerical data*; D008137:Longitudinal Studies; D008297:Male; D011247:Pregnancy; D018873:Pregnancy Rate; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D061685:Time-to-Pregnancy; D016896:Treatment Outcome
keywords: Effectiveness; Expectant management; Intrauterine insemination; Unexplained subfertility