[MP Test] Superovulation combined with intrauterine insemination yields higher pregnancy rates

Combined administration of superovulation (SO) and intrauterine insemination (IUI) yields higher pregnancy rates (PR) compared to either IUI, timed intercourse (TI), or SO alone, says an expert.

Associate Professor Yu Su Ling, director, Centre for Assisted Reproduction and senior consultant from the Department of Obstetrics and Gynaecology, Singapore General Hospital, Singapore, reviewed current evidence on the role of SO-IUI in fertility treatment.

A review of 14 randomized control trials has shown that IUI combined with SO increased birth rate compared to IUI alone (odds ratio [OR], 2.07, 95 percent confidence interval [CI], 1.22-3.50). There was also a higher likelihood of pregnancy with IUI compared to TI in stimulated cycles (OR, 1.68, 95 percent CI, 1.13-2.50). [Cochrane Database Syst Rev 2012;9:CD001838]

In a Singapore study of 797 SO-IUI cycles from 606 patients, younger women (<38 years of age) with ovulation disorders and unexplained fertility appeared to have the highest pregnancy rate with this combined assisted reproductive therapies. Overall, there were 127 pregnancies (PR, 15.9 percent) per treatment cycle. The study highlights the importance of patient selection in the success of SO-IUI. [Ann Acad Med Singapore 2014;43:225-231]

“When we compare different parameters, the PR and live birth rates were higher for the SO-IUI group versus for the timed intercourse, SO, or IUI alone group,” said Yu.

However, Yu highlighted that there was no significant difference in PR outcome when IUI was combined with either clomiphene citrate (CC) or gonadotropins (follicle-stimulating hormone) to induce SO. “There appears to be no significant difference between CC-IUI or FSH-IUI, and the former is cheaper and easier to administer,” she concluded.

Couples with infertility of unknown aetiology or have failed to conceive following standard therapies for cervical factor infertility, ovulatory dysfunction and endometriosis are usually suitable candidates for SO-IUI therapy.