Couples dropping out of a reimbursed intrauterine insemination program: what is their prognostic profile and why do they drop out?

OBJECTIVE: To evaluate whether baseline characteristics and prognostic profiles differed between couples who drop out from intrauterine insemination (IUI) and couples that continue IUI, and the reasons for couples dropping out from IUI programs. DESIGN: Retrospective observational cohort study. SETTING: Fertility centers. PATIENT(S): Consecutive subfertile couples undergoing IUI. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Characteristics and prognosis of ongoing pregnancy after IUI at the start of treatment of couples that dropped out compared with couples that continued treatment or achieved an ongoing pregnancy. RESULT(S): We studied 803 couples who underwent 3,579 IUI cycles of whom 221 couples dropped out (28%). Couples dropping out completed 2.8 (SD ±1.4) cycles per couple compared with 4.5 (SD ±2.3) cycles per couple for those continuing treatment. Couples dropping out had a higher female age, longer subfertility duration, and higher basal FSH. Mean prognosis to achieve an ongoing pregnancy after IUI at start of treatment was 7.9% (SD ±2.4) per cycle for couples who dropped out and 8.5% (SD ±2.5) per cycle for couples continuing treatment. Of the dropouts, 100 couples (45%) were actively censored from the IUI program, 87 couples (39%) because of poor prognosis; 121 couples (55%) were passively censored from the program, of whom 62 (28%) dropped out owing to personal reasons; 59 couples (27%) were lost to follow-up. CONCLUSION(S): We found significant differences in prognostic profile between couples continuing treatment and couples dropping out, although these differences seem limited from a clinical perspective. We conclude that overestimation of ongoing pregnancy rates after IUI due to couples dropping out is limited.

Immobilisation versus immediate mobilisation after intrauterine insemination: randomised controlled trial.

OBJECTIVE: To evaluate the effectiveness of 15 minutes of immobilisation versus immediate mobilisation after intrauterine insemination. DESIGN: Randomised controlled trial. Setting One academic teaching hospital and six non-academic teaching hospitals. PARTICIPANTS: Women having intrauterine insemination for unexplained, cervical factor, or male subfertility. INTERVENTIONS: 15 minutes of immobilisation or immediate mobilisation after insemination. MAIN OUTCOME MEASURE: Ongoing pregnancy per couple. RESULTS: 391 couples were randomised; 199 couples were allocated to 15 minutes of immobilisation after intrauterine insemination, and 192 couples were allocated to immediate mobilisation (control). The ongoing pregnancy rate per couple was significantly higher in the immobilisation group than in the control group: 27% (n=54) versus 18% (34); relative risk 1.5, 95% confidence interval 1.1 to 2.2 (crude difference in ongoing pregnancy rates: 9.4%, 1.2% to 17%). Live birth rates were 27% (53) in the immobilisation group and 17% (32) in the control group: relative risk 1.6, 1.1 to 2.4 (crude difference for live birth rates: 10%, 1.8% to 18%). In the immobilisation group, the ongoing pregnancy rates in the first, second, and third treatment cycles were 10%, 10%, and 7%. The corresponding rates in the mobilisation group were 7%, 5%, and 5%. CONCLUSION: In treatment with intrauterine insemination, 15 minutes' immobilisation after insemination is an effective modification. Immobilisation for 15 minutes should be offered to all women treated with intrauterine insemination. TRIAL REGISTRATION: Current Controlled Trials ISRCTN53294431.

Patients' preferences for intrauterine insemination or in-vitro fertilization.

Patients' preferences for intrauterine insemination (IUI) relative to IVF were assessed using trade-off interviews, and the number of IUI cycles they would undergo before changing to IVF. A total of 73 couples undergoing IUI with a total of 111 interviews were included. Scenarios were offered where pregnancy chance after IUI was varied against a fixed pregnancy rate after IVF. The impact of multiple pregnancy risk on the couple's preference was also investigated. Interviews were held before starting IUI, after three or four IUI cycles and after six IUI cycles. With decreasing probability of ongoing pregnancy after IUI, an increasing number of couples switched their preference from IUI to IVF. This switch occurred after six cycles at a significantly higher (P = 0.01) mean cumulative pregnancy rate (53%) compared with other groups (31%). With increasing risk of multiple pregnancy, preference for IUI declined only slightly, with mean risks of 73, 78 and 83% of a multiple pregnancy for the three groups respectively. In conclusion, at baseline and after three cycles of IUI the majority of couples undergoing IUI preferred continuation of IUI over IVF. A clear shift in preference towards IVF occurred after six cycles. Risk of multiple pregnancy did not affect preference for IUI with ovarian stimulation.