FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Previous Volume 340:177-183 January 21, 1999 Number 3 Next

	Full Text PDF Editorial by te Velde, E. R. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background Induction of superovulation with gonadotropins and intrauterine insemination are frequently used to treat infertility. We conducted a large, randomized, controlled clinical trial of these treatments.

Methods We studied 932 couples in which the woman had no identifiable infertility factor and the man had motile sperm. The couples were randomly assigned to receive intracervical insemination, intrauterine insemination, superovulation and intracervical insemination, or superovulation and intrauterine insemination. Treatment continued for four cycles unless pregnancy was achieved.

Results The 231 couples in the group treated with superovulation and intrauterine insemination had a higher rate of pregnancy (33 percent) than the 234 couples in the intrauterine-insemination group (18 percent), the 234 couples in the group treated with superovulation and intracervical insemination (19 percent), or the 233 couples in the intracervical-insemination group (10 percent). Stratified, discrete-time Cox proportional-hazards analysis showed that the couples in the group treated with superovulation and intrauterine insemination were 3.2 times as likely to become pregnant as those in the intracervical-insemination group (95 percent confidence interval, 2.0 to 5.3) and 1.7 times as likely as those in the intrauterine-insemination group (95 percent confidence interval, 1.2 to 2.6). The couples in the intrauterine-insemination group and in the group treated with superovulation and intracervical insemination were nearly twice as likely to conceive as those in the intracervical-insemination group.

Conclusions Among infertile couples, treatment with induction of superovulation and intrauterine insemination is three times as likely to result in pregnancy as is intracervical insemination and twice as likely to result in pregnancy as is treatment with either superovulation and intracervical insemination or intrauterine insemination alone.

Source Information

From the University of Rochester, Rochester, N.Y. (D.S.G.); Baylor College of Medicine, Houston (S.A.C., J.E.B.); University of Pennsylvania Medical Center, Philadelphia (C.C., L.M.); the University of California, Davis, Sacramento (J.W.O., S.T.N.); Columbia University, New York (P.F.-L., R.E.C.); the University of Alabama, Birmingham (M.P.S.); Harvard University, Boston (J.A.H.); and the National Institutes of Health, Bethesda, Md. (D.L.V.).

Address reprint requests to Dr. Carson at Baylor College of Medicine, Department of Obstetrics and Gynecology, 6550 Fannin #801, Houston, TX 77030, or at scarson{at}bcm.tmc.edu.

Full Text of this Article

Related Letters:

Efficacy of Superovulation and Intrauterine Insemination in the Treatment of Infertility
Dickey R., Sartor S. M., Pryzak R., Habbema J.D.F., Carson S. A., Guzick D. S., Vogel D. L., te Velde E. R., Cohlen B. J.
Extract | Full Text  
N Engl J Med 1999; 341:128-129, Jul 8, 1999. Correspondence

This article has been cited by other articles:

• Bhattacharya, S, Harrild, K, Mollison, J, Wordsworth, S, Tay, C, Harrold, A, McQueen, D, Lyall, H, Johnston, L, Burrage, J, Grossett, S, Walton, H, Lynch, J, Johnstone, A, Kini, S, Raja, A, Templeton, A (2008). Clomifene citrate or unstimulated intrauterine insemination compared with expectant management for unexplained infertility: pragmatic randomised controlled trial. BMJ 337: a716-a716 [Abstract] [Full Text]  
• Ombelet, W., Campo, R., Bosmans, E., Nijs, M. (2008). Intrauterine insemination (IUI) as a first-line treatment in developing countries and methodological aspects that might influence IUI success. ESHRE Monogr 2008: 64-72 [Abstract] [Full Text]  
• Edwards, S. E., Buffone, M. G., Knee, G. R., Rossato, M., Bonanni, G., Masiero, S., Ferasin, S., Gerton, G. L., Moss, S. B., Williams, C. J. (2007). Effects of Extracellular Adenosine 5'-Triphosphate on Human Sperm Motility. Reproductive Sciences 14: 655-666 [Abstract]  
• Dankert, T., Kremer, J.A.M., Cohlen, B.J., Hamilton, C.J.C.M., Pasker-de Jong, P.C.M., Straatman, H., van Dop, P.A. (2007). A randomized clinical trial of clomiphene citrate versus low dose recombinant FSH for ovarian hyperstimulation in intrauterine insemination cycles for unexplained and male subfertility. Hum Reprod 22: 792-797 [Abstract] [Full Text]  
• Crosignani, P.G., Somigliana, E., on behalf of the Intrauterine Insemination (IUI) S, (2007). Effect of GnRH antagonists in FSH mildly stimulated intrauterine insemination cycles: a multicentre randomized trial. Hum Reprod 22: 500-505 [Abstract] [Full Text]  
• Demirol, A., Gurgan, T. (2007). Comparison of different gonadotrophin preparations in intrauterine insemination cycles for the treatment of unexplained infertility: a prospective, randomized study. Hum Reprod 22: 97-100 [Abstract] [Full Text]  
• Allegra, A., Marino, A., Coffaro, F., Scaglione, P., Sammartano, F., Rizza, G., Volpes, A. (2007). GnRH antagonist-induced inhibition of the premature LH surge increases pregnancy rates in IUI-stimulated cycles. A prospective randomized trial. Hum Reprod 22: 101-108 [Abstract] [Full Text]  
• Bedaiwy, M. A., Forman, R., Mousa, N. A., Al Inany, H. G., Casper, R. F. (2006). Cost-effectiveness of aromatase inhibitor co-treatment for controlled ovarian stimulation. Hum Reprod 21: 2838-2844 [Abstract] [Full Text]  
• Cedrin-Durnerin, I., Massin, N., Galey-Fontaine, J., Bry-Gauillard, H., Roger, M., Lahlou, N., Hugues, J.N. (2006). Timing of FSH administration for ovarian stimulation in normo-ovulatory women: comparison of an early or a mid follicular phase initiation of a short-term treatment. Hum Reprod 21: 2941-2947 [Abstract] [Full Text]  
• Vermeylen, A.-M., D'Hooghe, T., Debrock, S., Meeuwis, L., Meuleman, C., Spiessens, C. (2006). The type of catheter has no impact on the pregnancy rate after intrauterine insemination: a randomized study. Hum Reprod 21: 2364-2367 [Abstract] [Full Text]  
• van Rumste, M.M.E., den Hartog, J.E., Dumoulin, J.C.M., Evers, J.L.H., Land, J.A. (2006). Is controlled ovarian stimulation in intrauterine insemination an acceptable therapy in couples with unexplained non-conception in the perspective of multiple pregnancies?. Hum Reprod 21: 701-704 [Abstract] [Full Text]  
• Lambalk, C.B., Leader, A., Olivennes, F., Fluker, M.R., Andersen, A. N., Ingerslev, J., Khalaf, Y., Avril, C., Belaisch-Allart, J., Roulier, R., Mannaerts, B. (2006). Treatment with the GnRH antagonist ganirelix prevents premature LH rises and luteinization in stimulated intrauterine insemination: results of a double-blind, placebo-controlled, multicentre trial. Hum Reprod 21: 632-639 [Abstract] [Full Text]  
• Van Voorhis, B. J. (2006). Outcomes From Assisted Reproductive Technology. Obstet Gynecol 107: 183-200 [Abstract] [Full Text]  
• Gracia, C. R., Sammel, M. D., Coutifaris, C., Guzick, D. S., Barnhart, K. T. (2005). Occupational Exposures and Male Infertility. Am J Epidemiol 162: 729-733 [Abstract] [Full Text]  
• van der Steeg, J. W., Steures, P., Hompes, P. G.A., Eijkemans, M. J.C., van der Veen, F., Mol, B. W.J. (2005). Investigation of the infertile couple: a basic fertility work-up performed within 12 months of trying to conceive generates costs and complications for no particular benefit. Hum Reprod 20: 2672-2674 [Abstract] [Full Text]  
• Paris, D. B.B.P., Taggart, D. A., Shaw, G., Temple-Smith, P. D., Renfree, M. B. (2005). Birth of Pouch Young after Artificial Insemination in the Tammar Wallaby (Macropus eugenii). Biol. Reprod. 72: 451-459 [Abstract] [Full Text]  
• Barlow, D. H. (2005). The debate on single embryo transfer in IVF. How will today's arguments be viewed from the perspective of 2020?. Hum Reprod 20: 1-3 [Full Text]  
• Ombelet, W., De Sutter, P., Van der Elst, J., Martens, G. (2005). Multiple gestation and infertility treatment: registration, reflection and reaction--the Belgian project. Hum Reprod Update 11: 3-14 [Abstract] [Full Text]  
• Nicopoullos, J. D.M., Almeida, P. A., Ramsay, J. W.A., Gilling-Smith, C. (2004). The effect of human immunodeficiency virus on sperm parameters and the outcome of intrauterine insemination following sperm washing. Hum Reprod 19: 2289-2297 [Abstract] [Full Text]  
• Steures, P., van der Steeg, J. W., Verhoeve, H. R., van Dop, P. A., Hompes, P. G.A., Bossuyt, P. M.M., van der Veen, F., Habbema, J.D. F., Eijkemans, M. J.C., Mol, B. W.J. (2004). Does ovarian hyperstimulation in intrauterine insemination for cervical factor subfertility improve pregnancy rates?. Hum Reprod 19: 2263-2266 [Abstract] [Full Text]  
• Mitwally, M. F. M., Casper, R. F. (2004). Aromatase Inhibition Reduces the Dose of Gonadotropin Required for Controlled Ovarian Hyperstimulation. Reproductive Sciences 11: 406-415 [Abstract]  
• Noah, L., Jain, T., Missmer, S. A., Hornstein, M. D. (2004). Trends in Assisted Reproductive Technology. NEJM 351: 398-399 [Full Text]  
• Brazil, C., Swan, S. H., Tollner, C. R., Treece, C., Drobnis, E. Z., Wang, C., Redmon, J. B., Overstreet, J. W. (2004). Quality Control of Laboratory Methods for Semen Evaluation in a Multicenter Research Study. J Androl 25: 645-656 [Abstract] [Full Text]  
• ESHRE Capri Workshop Group, (2004). Diagnosis and management of the infertile couple: missing information. Hum Reprod Update 10: 295-307 [Abstract] [Full Text]  
• Collins, J. A., Van Steirteghem, A. (2004). Overall prognosis with current treatment of infertility. Hum Reprod Update 10: 309-316 [Abstract] [Full Text]  
• Ragni, G., Alagna, F., Brigante, C., Riccaboni, A., Colombo, M., Somigliana, E., Crosignani, P.G. (2004). GnRH antagonists and mild ovarian stimulation for intrauterine insemination: a randomized study comparing different gonadotrophin dosages. Hum Reprod 19: 54-58 [Abstract] [Full Text]  
• Smith, S., Pfeifer, S. M., Collins, J. A. (2003). Diagnosis and Management of Female Infertility. JAMA 290: 1767-1770 [Full Text]  
• Mitwally, M.F.M., Casper, R.F. (2003). Aromatase inhibition reduces gonadotrophin dose required for controlled ovarian stimulation in women with unexplained infertility. Hum Reprod 18: 1588-1597 [Abstract] [Full Text]  
• de Ziegler, D. (2003). Associate editor's commentary: The dawning of the non-cancer uses of aromatase inhibitors in gynaecology. Hum Reprod 18: 1598-1602 [Full Text]  
• Strong, C. (2003). Too Many Twins, Triplets, Quadruplets, and So On: A Call for New Priorities. J Law Med Ethics 31: 272-282  
• Collins, J. (2003). Stimulated intra-uterine insemination is not a natural choice for the treatment of unexplained subfertility: Current best evidence for the advanced treatment of unexplained subfertility. Hum Reprod 18: 907-912 [Abstract] [Full Text]  
• Hughes, E. G. (2003). Stimulated intra-uterine insemination is not a natural choice for the treatment of unexplained subfertility: 'Effective treatment' or 'not a natural choice'?. Hum Reprod 18: 912-914 [Abstract] [Full Text]  
• Tesarik, J., Mendoza, C. (2003). Using the Male Gamete for Assisted Reproduction: Past, Present, and Future. J Androl 24: 317-328 [Full Text]  
• Bedaiwy, M. A., Sharma, R. K., Alhussaini, T. K., Mohamed, M. S., Aleem, A. M. A., Nelson, D. R., Thomas, A. J. Jr, Agarwal, A. (2003). The Use of Novel Semen Quality Scores to Predict Pregnancy in Couples With Male-Factor Infertility Undergoing Intrauterine Insemination. J Androl 24: 353-360 [Abstract] [Full Text]  
• Ferrara, I., Balet, R., Grudzinskas, J.G. (2002). Intrauterine insemination with frozen donor sperm. Pregnancy outcome in relation to age and ovarian stimulation regime. Hum Reprod 17: 2320-2324 [Abstract] [Full Text]  
• Hock, D. L., Seifer, D. B., Kontopoulos, E., Ananth, C. V. (2002). Practice Patterns Among Board-Certified Reproductive Endocrinologists Regarding High-Order Multiple Gestations: A United States National Survey. Obstet Gynecol 99: 763-770 [Abstract] [Full Text]  
• Miskry, T., Chapman, M. (2002). The use of intrauterine insemination in Australia and New Zealand. Hum Reprod 17: 956-959 [Abstract] [Full Text]  
• Cohn, B. A, Overstreet, J. W., Fogel, R. J., Brazil, C. K., Baird, D. D., Cirillo, P. M. (2002). Epidemiologic Studies of Human Semen Quality: Considerations for Study Design. Am J Epidemiol 155: 664-671 [Abstract] [Full Text]  
• Guzick, D. S., Overstreet, J. W., Factor-Litvak, P., Brazil, C. K., Nakajima, S. T., Coutifaris, C., Carson, S. A., Cisneros, P., Steinkampf, M. P., Hill, J. A., Xu, D., Vogel, D. L., the National Cooperative Reproductive Medicine Net, (2001). Sperm Morphology, Motility, and Concentration in Fertile and Infertile Men. NEJM 345: 1388-1393 [Abstract] [Full Text]  
• Baird, D. T. (2001). Is there a place for different isoforms of FSH in clinical medicine?: IV. The clinician's point of view. Hum Reprod 16: 1316-1318 [Abstract] [Full Text]  
• Glazener, C.M.A., Ford, W.C.L. (2001). Routine postcoital testing is unnecessary. Hum Reprod 16: 1052-1053 [Full Text]  
• Balasch, J. (2000). Investigation of the infertile couple: Investigation of the infertile couple in the era of assisted reproductive technology: a time for reappraisal. Hum Reprod 15: 2251-2257 [Abstract] [Full Text]  
• Comhaire, F. (2000). Clinical andrology: from evidence-base to ethics: The `E' quintet in clinical andrology. Hum Reprod 15: 2067-2071 [Abstract] [Full Text]  
• Workshop Group, T. E. C. (2000). Multiple gestation pregnancy. Hum Reprod 15: 1856-1864 [Abstract] [Full Text]  
• Gleicher, N., Oleske, D. M., Tur-Kaspa, I., Vidali, A., Karande, V. (2000). Reducing the Risk of High-Order Multiple Pregnancy after Ovarian Stimulation with Gonadotropins. NEJM 343: 2-7 [Abstract] [Full Text]  
• Bhattacharya, S., Templeton, A. (2000). In Treating Infertility, Are Multiple Pregnancies Unavoidable?. NEJM 343: 58-60 [Full Text]  
• Matorras, R., Recio, V., Corcostegui, B., Rodriguez-Escudero, F.J. (2000). Recombinant human FSH versus highly purified urinary FSH: a randomized study in intrauterine insemination with husbands' spermatozoa. Hum Reprod 15: 1231-1234 [Abstract] [Full Text]  
• Bertarelli Foundation Scientific Board, T. (2000). Public perception on infertility and its treatment: an international survey. Hum Reprod 15: 330-334 [Abstract] [Full Text]  
• Van der Auwera, I., Pijnenborg, R., Koninckx, P.R. (1999). The influence of in-vitro culture versus stimulated and untreated oviductal environment on mouse embryo development and implantation. Hum Reprod 14: 2570-2574 [Abstract] [Full Text]  
• Dickey, R., Sartor, S. M., Pryzak, R., Habbema, J.D.F., Carson, S. A., Guzick, D. S., Vogel, D. L., te Velde, E. R., Cohlen, B. J. (1999). Efficacy of Superovulation and Intrauterine Insemination in the Treatment of Infertility. NEJM 341: 128-129 [Full Text]  
• (1999). Superovulation and IUI: Effective for Infertility. JWatch Women's Health 1999: 3-3 [Full Text]  
• te Velde, E. R., Cohlen, B. J. (1999). The Management of Infertility. NEJM 340: 224-226 [Full Text]