OVULATION INDUCTION WITH GONADOTROPINS AND INTRAUTERINE INSEMINATION COMPARED WITH IN-VITRO FERTILIZATION AND NO THERAPY - A PROSPECTIVE, NONRANDOMIZED, COHORT STUDY AND METAANALYSIS

Objectives: To determine whether one to four cycles of ovulation induc tion with hMG and IUI or one cycle of IVF results in the highest pregn ancy rate and is least expensive and whether published pregnancy rates for one to four cycles of hMG and IUI results in a higher pregnancy r ate than rates for one cycle of IVF, zygote intrafallopian transfer (Z IFT), or GIFT. Design: Prospective, nonrandomized, cohort study. Patie nts were excluded who were infertile for <18 months, had a significant male factor, had greater than mild endometriosis, or had bilateral no npatency of the fallopian tubes. Cohort groups included 47 hMG and IUI patients (99 cycles), 19 IVF patients (19 cycles), and 21 patients (2 10 cycles) receiving no treatment. A meta-analysis on accumulated hMG and IUI data using similar entry criteria was also performed. Theoreti cal calculations were performed and stable fecundity assumed to compar e with national data on IVF, ZIFT, and GIFT. Setting: Fertility Center , Division of Reproductive Endocrinology, University of Utah, Salt Lak e City, Utah. Results: A course of therapy with one to four cycles of hMG and IUI was just as effective as one cycle of IVF in achieving pre gnancy. No significant difference in pregnancy rates was found between one IVF cycle and one to four cycles of hMG and IUI in our population . In vitro fertilization was more expensive than four cycles of hMG an d IUI. Both IVF and hMG and IUI were more effective than no therapy. P ublished data also suggest that four cycles of hMG and IUI theoretical ly result in higher pregnancy rates than one cycle of IVF, ZIFT, or GI FT. Conclusion: Cost-benefit analysis comparing hMG and IUI, IVF, and no therapy in infertility patients may favor a course of four cycles o f hMG and IUI as the first line of therapy. Using meta-analysis and th eoretical assumptions, the pregnancy rate for one cycle of hMG and IUI is inferior to IVF, GIFT, or ZIFT; two cycles are comparable to IVF o r ZIFT and inferior to GIFT; three cycles are superior to IVF or ZIFT and comparable to GIFT; and four cycles are theoretically superior to all techniques.