Efficacy and safety of intrauterine insemination in patients with moderate-to-severe endometriosis
Open accessAbstract
Performing intrauterine insemination (IUI) in moderate-to-severe endometriosis patients is not implemented in international guidelines, as only limited data exist on treatment efficacy and safety. This retrospective study examined the efficacy and safety of two IUI treatment strategies performed between January 2007 and July 2012 in moderate-to-severe endometriosis patients. Eight (40.0%) versus seven (15.6%) ongoing pregnancies were accomplished in patients undergoing IUI with ovarian stimulation (n=20, 61 cycles) versus IUI without ovarian stimulation in the first three cycles followed by IUI with ovarian stimulation (IUI with natural/ovarian stimulation; n=45, 184 cycles). Preceding long-term pituitary down-regulation tended to result in a higher ongoing pregnancy rate (adjusted HR 1.8) and a higher chance of endometriosis recurrence (adjusted HR 2.3). Eight (40.0%) versus 16 (35.6%) recurrences of endometriosis complaints were reported in patients receiving IUI with ovarian stimulation versus IUI with natural/ovarian stimulation. IUI might be a valuable treatment in moderate-to-severe endometriosis patients and IUI with ovarian stimulation should be offered over IUI with natural/ovarian stimulation. Preceding long-term pituitary down-regulation might positively influence the ongoing pregnancy rate and can be considered. Whether this treatment strategy can be structurally offered prior to IVF must be investigated in a randomized controlled trial.
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The value of IUI in infertile women with rASRM stage III/IV endometriosis with tubal patency is uncertain.
“Although the value of IUI in infertile women with rASRM stage III/IV endometriosis with tubal patency is uncertain, the use of IUI with ovarian stimulation could be considered (van der Houwen et al., 2014).”
From ESHRE guideline: endometriosis (2022) · cites this paper as van der Houwen et al., 2014
The risk of endometriosis recurrence appears to be increased by IUI and was reported to be higher than after IVF.
“Lastly, the risk of endometriosis recurrence appears to be increased by IUI (Van der Houwen et al., 2014) and was reported to be higher than after IVF D’Hooghe et al., (2006).”
From When more is not better: 10 ‘don’ts’ in endometriosis management. An ETIC* position statement (2019) · cites this paper as Van der Houwen et al., 2014
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<i>Endometriosis and Infertility</i>: <i>Epidemiology and Evidence‐based Treatments</i>
Ozkan, S., Murk, W., & Arici, A. (2008) · Annals of the New York Academy of Sciences · doi:10.1196/annals.1434.007 · Cited by 347 · see citing works
Is the endometriosis recurrence rate increased after ovarian hyperstimulation?
D’Hooghe, T. M., Denys, B., Spiessens, C., Meuleman, C., & Debrock, S. (2006) · Fertility and Sterility · doi:10.1016/j.fertnstert.2006.01.016 · Cited by 112 · see citing works
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Research works printed but not linked: 1
- Macer, M.L., Taylor, H.S., 2012. Endometriosis and infertility: a review of pathogenesis and treatment of endometriosis associ- ated infertility. Obstet. Gynecol. Clin. North Am. 39, 535-549.
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ESHRE guideline: endometriosis
Becker, C. M., Bokor, A., Heikinheimo, O., Horne, A., Jansen, F., Kiesel, L., King, K., Kvaskoff, M., Nap, A., Petersen, K., et al. (2022) · Human Reproduction Open · doi:10.1093/hropen/hoac009 · Cited by 1,712 · see citing works
“Although the value of IUI in infertile women with rASRM stage III/IV endometriosis with tubal patency is uncertain, the use of IUI with ovarian stimulation could be considered (van der Houwen et al. , 2014).”
Self-citationRethinking mechanisms, diagnosis and management of endometriosis
Chapron, C., Marcellin, L., Borghese, B., & Santulli, P. (2019) · Nature Reviews Endocrinology · doi:10.1038/s41574-019-0245-z · Cited by 1,084 · see citing works
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Endometriosis and infertility: Insights into the causal link and management strategies
Tomassetti, C., & D'Hooghe, T. (2018) · Best Practice & Research Clinical Obstetrics & Gynaecology · doi:10.1016/j.bpobgyn.2018.06.002 · Cited by 132 · see citing works
When more is not better: 10 ‘don’ts’ in endometriosis management. An ETIC* position statement
Club, E. E. T. I., Alio, L., Angioni, S., Arena, S., Bartiromo, L., Bergamini, V, Berlanda, N., Bonin, C., Busacca, M., Candiani, M., et al. (2019) · Human Reproduction Open · doi:10.1093/hropen/hoz009 · Cited by 64 · see citing works
- Authors
- van der Houwen, L. E. E., Schreurs, A. M. F., Schats, R., Heymans, M. W., Lambalk, C. B., Hompes, P. G. A., & Mijatovic, V.
- Affiliations
- Amsterdam UMC Location Vrije Universiteit Amsterdam (NL)
- Venue
- Reproductive BioMedicine Online
- Publisher
- Elsevier BV
- Published
- 2014-05
- Volume
- 28
- Issue
- 5
- Pages
- 590-598
- ISSN
- 1472-6483 (ISSN-L)
- OpenAlex
- W2127719966
- Cited by
- 39
- References
- 2
- Citations by year
- 2026: 2 · 2024: 5 · 2023: 2 · 2022: 5 · 2021: 3 · 2020: 1 · 2019: 6 · 2018: 5 · 2017: 4 · 2016: 1 · 2015: 3 · 2014: 2
- FWCI
- 4.03
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Reproductive BioMedicine Online (publishedVersion)
- PubMed (publishedVersion)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion)
- Pure Amsterdam UMC (submittedVersion)
- VU Research Portal (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Topics
- Health Sciences › Medicine › Reproductive Medicine › Endometriosis Research and Treatment
- Health Sciences › Medicine › Reproductive Medicine › Reproductive Health and Technologies
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ectopic Pregnancy Diagnosis and Management
- Keywords
- intrauterine insemination, endometriosis, ovulation induction, pituitary down-regulation, endometriosis recurrence, ongoing pregnancy rate, infertility treatment, treatment safety, treatment efficacy, GnRH antagonist protocol, GnRH agonist protocol
- MeSH terms
- Adult, Endometriosis, Female, Humans, Infertility, Female, Insemination, Artificial, Male, Ovarian Diseases, Pregnancy, Retrospective Studies, Severity of Illness Index, Treatment Outcome, Pregnancy Rate, Time-to-Pregnancy
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