Intrauterine insemination or in-vitro fertilisation in idiopathic subfertility and male subfertility: a randomised trial and cost-effectiveness analysis
Abstract
Background Couples affected by idiopathic subfertility or male subfertility have an estimated spontaneous conception rate of about 2% per cycle. Although various infertility treatments are available, counselling of a couple in their choice of treatment is difficult because of the lack of consistent data from good-quality comparative studies. We compared the results of treatment with intrauterine insemination (IUI) with those of in-vitro fertilisation (IVF), and did a cost-effectiveness analysis. Methods In a prospective, randomised, parallel trial, 258 couples with idiopathic subfertility or male subfertility were treated for a maximum of six cycles of either IUI in the spontaneous cycle (IUI alone), IUI after mild ovarian hyperstimulation, or IVF. The primary endpoint was a pregnancy resulting in at least one livebirth after treatment. Cost-effectiveness based on real costs was studied by Markov chain analysis. Findings 86 couples were assigned IUI alone, 85 IUI plus ovarian hyperstimulation, and 87 IVF. Ten couples dropped out before treatment began. Although the pregnancy rate per cycle was higher in the IVF group than in the IUI groups (12.2% vs 7.4% and 8.7%, respectively; p=0.09), the cumulative pregnancy rate for IVF was not significantly better than that for IUI. Couples in the IVF group were more likely than those in the IUI groups to give up treatment before their maximum of six attempts (37 [42%] drop-outs vs 13 [15%] and 14 [16%], respectively; p Interpretation Co…
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IVF and ICSI carry significantly increased potential cost and morbidity to the patient and offspring compared with IUI.
“However, IVF and ICSI come with significantly increased potential cost and morbidity to the patient and offspring compared to IUI (Goverde et al., 2000).”
From Isolated abnormal strict morphology is not a contraindication for intrauterine insemination (2015) · cites this paper as Goverde et al., 2000
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- Authors
- Goverde, A. J., McDonnell, J., Vermeiden, J. P., Schats, R., Rutten, F. F., & Schoemaker, J.
- Affiliations
- Amsterdam UMC Location Vrije Universiteit Amsterdam (NL)
- Erasmus University Rotterdam (NL)
- Corresponding author
- Goverde, Angelique J
- ORCID
- Goverde, Angelique J
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 2000-01
- Volume
- 355
- Issue
- 9197
- Pages
- 13-18
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- OpenAlex
- W2110055479
- Cited by
- 453
- References
- 26
- Citations by year
- 2026: 3 · 2025: 5 · 2024: 3 · 2023: 6 · 2022: 11 · 2021: 19 · 2020: 13 · 2019: 14 · 2018: 12 · 2017: 18 · 2016: 19 · 2015: 14 · 2014: 12 · 2013: 24 · 2012: 16
- FWCI
- 20.78
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Lancet (publishedVersion)
- PubMed (publishedVersion)
- DigitalGeorgetown (Georgetown University Library) (submittedVersion)
- Topics
- Health Sciences › Medicine › Reproductive Medicine › Reproductive Health and Technologies
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Assisted Reproductive Technology and Twin Pregnancy
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Reproductive Biology and Fertility
- Keywords
- in vitro fertilization, male subfertility, cost-effectiveness, ovarian hyperstimulation, treatment discontinuation, Markov chain analysis
- MeSH terms
- Adult, Cost-Benefit Analysis, Female, Fertilization in Vitro, Humans, Infertility, Insemination, Artificial, Male, Markov Chains, Pregnancy, Sperm Count, Treatment Outcome
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