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. DESIGN: Randomized pilot trial. SETTING: Three academic and six teaching hospitals in the Netherlands. PATIENT(S): Couples with unexplained or mild male subfertility and an unfavorable prognosis for natural conception. INTERVENTION(S): One cycle of IVF-eSET or three cycles of IUI-COS. MAIN OUTCOME MEASURE(S): Ongoing pregnancy per couple. RESULT(S): We randomly allocated 116 women toIVF-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%). CONCLUSION(S): 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.
RCT Entities:
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. DESIGN: Randomized pilot trial. SETTING: Three academic and six teaching hospitals in the Netherlands. PATIENT(S): Couples with unexplained or mild male subfertility and an unfavorable prognosis for natural conception. INTERVENTION(S): One cycle of IVF-eSET or three cycles of IUI-COS. MAIN OUTCOME MEASURE(S): Ongoing pregnancy per couple. RESULT(S): 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%). CONCLUSION(S): 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: Yu-Han Chiu; Jennifer J Yland; Paolo Rinaudo; John Hsu; Sean McGrath; Sonia Hernández-Díaz; Miguel A Hernán Journal: Fertil Steril Date: 2022-03-16 Impact factor: 7.490
Authors: Lucy Prentice; Lynn Sadler; Sarah Lensen; Melissa Vercoe; Jack Wilkinson; Richard Edlin; Georgina M Chambers; Cynthia M Farquhar Journal: Hum Reprod Open Date: 2020-09-22
Authors: Rui Wang; Nora A Danhof; Raissa I Tjon-Kon-Fat; Marinus Jc Eijkemans; Patrick Mm Bossuyt; Monique H Mochtar; Fulco van der Veen; Siladitya Bhattacharya; Ben Willem J Mol; Madelon van Wely Journal: Cochrane Database Syst Rev Date: 2019-09-05
Authors: A J Bensdorp; R I Tjon-Kon-Fat; P M M Bossuyt; C A M Koks; G J E Oosterhuis; A Hoek; P G A Hompes; F J M Broekmans; H R Verhoeve; J P de Bruin; R van Golde; S Repping; B J Cohlen; M D A Lambers; P F van Bommel; E Slappendel; D Perquin; J M Smeenk; M J Pelinck; J Gianotten; D A Hoozemans; J W M Maas; M J C Eijkemans; F van der Veen; B W J Mol; M van Wely Journal: BMJ Date: 2015-01-09