Controlled ovarian hyperstimulation and intrauterine insemination for treatment of unexplained infertility should be limited to a maximum of three trials

Objective: To investigate the optimum number of cycles of controlled ovaria n hyperstimulation and intrauterine insemination in the treatment of unexpl ained infertility. Design: Observational prospective study. Setting: In vitro fertilization embryo transfer center. Patient(s): Five hundred ninety-four couples with unexplained infertility. Intervention(s): Controlled ovarian hyperstimulation (COH), intrauterine in semination (IUI), in vitro fertilization (IVF), and intracytoplasmic sperm injection (ICSI). Main Outcome Measure(s): Cycle fecundity. Result(s): One to 3 cycles of COH/IUI were performed in 594 patients (group A) undergoing 1,112 cycles (mean, 1.9 cycles/patient). Up to 3 further tri als (cycles 4-6) of COH/IUI were then performed in 91 of these women (group B), a total of 161 cycles (mean, 1.8 cycles/patient). A historical compari son group C consisted of 131 patients with 3 failed cycles of COH/IUI who u nderwent 1 cycle of IVF and ICSI at our center. In group A, 182 pregnancies occurred, with a cycle fecundity of 16.4% and a cumulative pregnancy rate (PR) of 39.2% after the first 3 cycles. In group B, 9 pregnancies occurred in cycles 4-6, with a cycle fecundity of 5.6%, significantly lower than tha t of group A (P<.001). The cumulative PR rose to 48.5% by cycle 6, a furthe r increase of only 9.3%. In the women undergoing IVF and ICSI in group C, 4 8 pregnancies occurred, with a cycle fecundity of 36.6% per cycle, signific antly higher than that of group B (P<.001). Conclusion(s): in unexplained infertility, the cycle fecundity in the first three trials of COH and IUI was higher than in cycles 4-6, with a statisti cally significant difference. Patients should be offered IVF or ICSI if the y fail to conceive after three trials of COH and IUI. (C) 2001 by American Society for Reproductive Medicine.