Alexandra J Bensdorp1, Raissa Tjon-Kon-Fat2, Harold Verhoeve3, Carolien Koks4, Peter Hompes5, Annemieke Hoek6, Jan Peter de Bruin7, Ben Cohlen8, Diederik Hoozemans9, Frank Broekmans10, Peter van Bomme11, Jesper Smeenk12, Ben W J Mol13, Fulco van der Veen2, Madelon van Wely2. 1. Centre for Reproductive Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands. Electronic address: a.j.bensdorp@amc.uva.nl. 2. Centre for Reproductive Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands. 3. OLVG, Department of Obstetrics and Gynaecology, Amsterdam, The Netherlands. 4. Máxima Medical Centre, Department of Obstetrics and Gynaecology, Veldhoven, The Netherlands. 5. Vrije Universiteit Medical Centre, Centre for Reproductive Medicine, Amsterdam, The Netherlands. 6. University Medical Centre Groningen, University of Groningen, Department of Obstetrics and Gynaecology, Groningen, The Netherlands. 7. Jeroen Bosch Hospital, Department of Obstetrics and Gynaecology, 's Hertogenbosch, The Netherlands. 8. Isala Clinics, Department of Obstetrics and Gynaecology, Zwolle, The Netherlands. 9. Medical Spectrum Twente, Department of Obstetrics and Gynaecology, Enschede, The Netherlands. 10. University Medical Centre Utrecht, Department for Reproductive Medicine, Utrecht, The Netherlands. 11. Amphia Hospital, Department of Obstetrics and Gynaecology, Breda, The Netherlands. 12. Elisabeth Hospital, Department of Obstetrics and Gynaecology, Tilburg, The Netherlands. 13. The Robinson Research Institute, School of Paediatrics and Reproductive Health University of Adelaide, Adelaide, Australia; The South Australian Health and Medical Research Institute, Adelaide, Australia.
Abstract
OBJECTIVE: To compare dropout rates in couples undergoing conventional in vitro fertilization with single embryo transfer (IVF-SET), in vitro fertilization in a modified natural cycle (IVF-MNC) or intrauterine insemination with ovarian stimulation (IUI-OS). STUDY DESIGN: Secondary analysis of a multicentre randomized controlled trial between January 2009 and February 2012. 602 couples with unexplained or mild male subfertility, allocated to IVF-SET (N=201), IVF-MNC (N=194) and IUI-OS (N=207). MAIN OUTCOME MEASURES: Dropouts, defined as couples who discontinued their allocated three cycles of IVF-SET, six cycles of IVF-MNC or IUI-OS, without having achieved a pregnancy. We classified dropouts as "following medical advice" or "patient initiated". RESULT(S): Thirty couples (15%) allocated to IVF-SET dropped out and 45 couples (23%) allocated to IVF-MNC, compared to 26 couples (13%) allocated to IUI-OS; relative risk (RR) 1.2 (95%CI; 0.73-1.9) for IVF-SET and 1.9 (95%CI; 1.2-2.9) for IVF-MNC, both compared to IUI-OS. Nine couples (4.5%) allocated to IVF-SET, 14 (7.2%) allocated to IVF-MNC and 14 (6.8%) allocated to IUI-OS dropped out following medical advice; RR of 0.51 (95%CI; 0.21-1.2) for IVF-SET and 0.84 (95%CI; 0.39-1.80) for IVF-MNC, both versus IUI-OS. Twenty-one couples (10%) allocated to IVF-SET were patient initiated dropouts, as were 31 (16%) allocated to IVF-MNC and 12 (5.8%) allocated to IUI-COS; RR 1.8 (95%CI; 0.91-3.6) for IVF-SET and 2.8 (95%CI; 1.5-5.2) for IVF-MNC both versus IUI-OS. CONCLUSION(S): IVF-SET and IUI-OS result in comparable drop-out rates, while drop-out rates after IVF-MNC are almost twice as high, mainly driven by patient preferences.
RCT Entities:
OBJECTIVE: To compare dropout rates in couples undergoing conventional in vitro fertilization with single embryo transfer (IVF-SET), in vitro fertilization in a modified natural cycle (IVF-MNC) or intrauterine insemination with ovarian stimulation (IUI-OS). STUDY DESIGN: Secondary analysis of a multicentre randomized controlled trial between January 2009 and February 2012. 602 couples with unexplained or mild male subfertility, allocated to IVF-SET (N=201), IVF-MNC (N=194) and IUI-OS (N=207). MAIN OUTCOME MEASURES: Dropouts, defined as couples who discontinued their allocated three cycles of IVF-SET, six cycles of IVF-MNC or IUI-OS, without having achieved a pregnancy. We classified dropouts as "following medical advice" or "patient initiated". RESULT(S): Thirty couples (15%) allocated to IVF-SET dropped out and 45 couples (23%) allocated to IVF-MNC, compared to 26 couples (13%) allocated to IUI-OS; relative risk (RR) 1.2 (95%CI; 0.73-1.9) for IVF-SET and 1.9 (95%CI; 1.2-2.9) for IVF-MNC, both compared to IUI-OS. Nine couples (4.5%) allocated to IVF-SET, 14 (7.2%) allocated to IVF-MNC and 14 (6.8%) allocated to IUI-OS dropped out following medical advice; RR of 0.51 (95%CI; 0.21-1.2) for IVF-SET and 0.84 (95%CI; 0.39-1.80) for IVF-MNC, both versus IUI-OS. Twenty-one couples (10%) allocated to IVF-SET were patient initiated dropouts, as were 31 (16%) allocated to IVF-MNC and 12 (5.8%) allocated to IUI-COS; RR 1.8 (95%CI; 0.91-3.6) for IVF-SET and 2.8 (95%CI; 1.5-5.2) for IVF-MNC both versus IUI-OS. CONCLUSION(S): IVF-SET and IUI-OS result in comparable drop-out rates, while drop-out rates after IVF-MNC are almost twice as high, mainly driven by patient preferences.
Authors: Anna M Modest; Lauren A Wise; Matthew P Fox; Jennifer Weuve; Alan S Penzias; Michele R Hacker Journal: Hum Reprod Date: 2018-12-01 Impact factor: 6.918