COMPARISON BETWEEN STIMULATED IN-VITRO FERTILIZATION AND STIMULATED INTRAUTERINE INSEMINATION FOR THE TREATMENT OF UNEXPLAINED AND MILD MALE FACTOR INFERTILITY

A prospective trial was undertaken to evaluate the efficacy of stimula ted in-vitro fertilization (SIVF) and stimulated intrauterine insemina tion (SIUI) in couples with unexplained and mild male factor infertili ty. In all, 80 couples were allocated to treatment with SIVF or SIUI, both treatments following the same [clomiphene citrate and follicle st imulating (FSH) injection], except that higher doses of FSH were used in the SIVF treatment cycles. Initially, 41 couples were allocated to and started treatment with SIVF but eight cases were eventually conver ted to SIUI because of under-response. Similarly, although 39 couples were initially allocated to SIUI treatment, five of these converted to SIVF because of over-response. The treatment cycles that were convert ed either to SIUI or to SIVF were not considered as treatment failures but as treatment changes and so were included in the analyses. Of the final 38 SIVF cycles, four were cancelled (dysfunctional response), f ailed fertilization occurred in five cycles and 29 subjects reached em bryo transfer. There were two biochemical pregnancies [positive human chorionic gonadotrophin (HCG) only], two clinical abortions and seven live births. Of the final 42 SIUI cycles, only two were cancelled, ins emination being performed in the remaining 40 cases. The result was on e clinical abortion, three ectopics and eight live births. The proport ion of cycles with positive HCG was identical (28.9% per cycle treated for SIVF and 28.6% for SIUI) and the livebirth rates were also not di fferent (18.4% per cycle treated for SIVF and 19.0% for SIUI). The cos t per maternity of SIUI was approximately half that of SIVF (pound 192 3 versus pound 4611) and so we conclude that, as SIUI had an efficacy that was not significantly different from SIVF (using similar protocol s) but was more cost-effective, it must be considered the more appropr iate form of management for the treatment of unexplained and mild male factor infertility. Indeed, it is hard to justify the routine use of IVF, as a first approach, in unexplained infertility.