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VF facilities. Located at new outpatient therapy center offering the latest in laparoscopy and hysteroscopy. Accomodations for visitors are nearby, safe, and inexpensive.

IUI and Ovulation Induction: Reviewing the Data and Advising Patients
Title:The effectiveness of ovulation induction and intrauterine insemination in the treatment of persistant infertility: meta-analysis
Author: E. Hughes
Address:Pittsburgh, Pennsylvania
Source:Human Reproduction 12: 1865-1871 (September) 1997
Summary:When less aggressive interventions have failed, couples frequently undergo one or more treatment cycles using gonadotropins for ovarian stimulation. This may occur with or without intrauterine insemination (IUI ), before advancing to the consideration of IVF. There are obvious economic and minimal intervention advantages to this approach but there are disadvantages such as: hyperstimulation syndrome and multiple pregnancy risk ( a timely topic of discussion). This systematic review using two approaches to meta-analysis evaluates the effectiveness of IUI with or without gonadotropin (FSH) in the treatment of persistant infertility. Randomized control trials were identified from 1966 to the present. First, the Mantel- Haenzel approach of meta-analysis was applied to 8 trials comparing FSH/ IUI with FSH/ timed intercourse. The common odds ratio for pregnancy was 2.37 [95% confidence interval (CI), 1.43,3.90. This suggests a significant improvement in fecundity for those couples participating in IUI following ovulation induction. The second meta-analysis evaluated the independent effects of treatment with FSH, clomiphene citrate, IUI, male factor and endometriosis using a stepwise logistic regression. 22 trials including a total of 5214 cycles were analyzed.The odds ratios were: FSH was 2.35 (95% CI, 1.87-2.94); IUI, 282 (95% CI 2.18,3.66); male factor; 0.48 (95% CI .0.37, 0.61; and endometriosis, 0.45 (95%CI 0.27, 0.76). Clomiphene citrate failed to enter the regression model. It is hoped that this review will prove useful for the clinician when counseling couples as to their treatment options concerning persistant infertility treatment . An example of applying this meta-analysis overview to counseling efforts might be: a couple with 4 years of primary male factor infertility would have a fecundity rate of 1%. This data suggests that a combination of IUI with FSH for ovarian stimulation would increase this fecundity rate to 5%. Or a couple with 2 years of unexplained secondary infertility could increase their rate of 4% to 8% using IUI with FSH for ovarian stimulation. The authors note that there is a need for future studies evaluating IUI/FSH versus no treatment Comment:IUI represents a good method for semen analysis and if properly timed, it probably has a positive effect on fertiltiy in the first several cycles. Itsą usefulness is highly questionable in multiple attempts. Since sperm are activated in the preparation process for IUI and since the cervical reservoir is by-passed with the procedure, it is critically important to time the IUI to just before ovulation. This timing is improved in gonadotropin cycles with hCG induced ovulation and may account for the slightly increased pregancy rates reported in these cycles. Results remain equivocal as to the role of IUI in natural or clomiphene stimulated cycles.