When is clomiphene or gonadotropin intrauterine insemination futile Results of the Fast Track and Standard Treatment Trial and the Forty and Over Treatment Trial two prospective randomized controlled trials

Controlled ovarian hyperstimulation with intrauterine insemination may be futile for infertile couples of any age with follicle stimulating hormone levels of 10–15 mIU/mL and estradiol 40 pg/mL.

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Authors

Daniel J. Kaser, M.D., Marlene B. Goldman, Sc.D., June L. Fung, Ph.D., Michael M. Alper, M.D., Richard H. Reindollar, M.D.

Volume 102, Issue 5, Pages 1331–1337.e1

Abstract

Objective:

To determine whether day 3 FSH and E2 levels at the upper limits of normal affect live-birth rates and treatment trajectory in a conventional versus “fast track” treatment program for IVF.

Design:

Secondary analysis of two randomized controlled trials, FASTT and FORT-T.

Setting:

Multicenter study in a state with mandated insurance coverage.

Patient(s):

Infertile women ages 21–42 years randomized to conventional or accelerated treatment with controlled ovarian hyperstimulation (COH)-IUI and/or IVF (n = 603 patients contributing 2,717 total cycles).

Intervention(s):

Patients were stratified according to basal FSH and E2: FSH <10 mIU/mL and E2 <40 pg/mL (group 1A), FSH <10 mIU/mL and E2 ≥40 pg/mL (group 1B), FSH, 10–15 mIU/mL and E2 <40 pg/mL (group 2A), and FSH, 10–15 mIU/mL and E2 ≥40 pg/mL (group 2B). Main Outcome Measure(s):

Number of cancelled cycles, disenrollment for poor response, and cumulative live-birth rates per couple.

Result(s):

Women in groups 2A and 2B were more likely to have cancelled cycles and be disenrolled for poor response. While no live births occurred in group 2B during COH-IUI (0/19 couples, 0/58 cycles), IVF still afforded these patients a reasonable chance of success (6/18 couples, 6/40 cycles, 33.3% live-birth rate per couple). The specificity and positive predictive value of basal FSH of 10–15 mIU/mL and E2 ≥40 pg/mL for no live birth during COH-IUI treatment were both 100%.

Conclusion(s):

Women who initiated infertility treatment with FSH of 10–15 mIU/mL and E2 ≥40 pg/mL on day 3 testing were unlikely to achieve live birth after COH-IUI treatment.

Read the full text at: http://www.fertstert.org/article/S0015-0282(14)01880-9/fulltext


Fertility and Sterility

Editorial Office, American Society for Reproductive Medicine

Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders. The journal publishes juried original scientific articles in clinical and laboratory research relevant to reproductive endocrinology, urology, andrology, physiology, immunology, genetics, contraception, and menopause. Fertility and Sterility® encourages and supports meaningful basic and clinical research, and facilitates and promotes excellence in professional education, in the field of reproductive medicine.

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