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Low-dose human menopausal gonadotrophin versus clomiphene citrate in subfertile couples treated with intrauterine insemination: a randomized controlled trial.
Peeraer, Karen; Debrock, Sophie; De Loecker, Peter; Tomassetti, C; Laenen, A; Welkenhuysen, M; Meeuwis, L; Pelckmans, S; Mol, B W; Spiessens, C; De Neubourg, D; D'Hooghe, T M.
Afiliación
  • Peeraer K; Leuven University Fertility Center, UZ Leuven Campus Gasthuisberg, 3000 Leuven, Belgium.
  • Debrock S; Leuven University Fertility Center, UZ Leuven Campus Gasthuisberg, 3000 Leuven, Belgium.
  • De Loecker P; Leuven University Fertility Center, UZ Leuven Campus Gasthuisberg, 3000 Leuven, Belgium.
  • Tomassetti C; Leuven University Fertility Center, UZ Leuven Campus Gasthuisberg, 3000 Leuven, Belgium.
  • Laenen A; Leuven Biostatistics and Statistical Bioinformatics Centre, Leuven, Belgium.
  • Welkenhuysen M; Leuven University Fertility Center, UZ Leuven Campus Gasthuisberg, 3000 Leuven, Belgium.
  • Meeuwis L; Leuven University Fertility Center, UZ Leuven Campus Gasthuisberg, 3000 Leuven, Belgium.
  • Pelckmans S; Leuven University Fertility Center, UZ Leuven Campus Gasthuisberg, 3000 Leuven, Belgium.
  • Mol BW; The Robinson Institute, School of Paediatrics and Reproductive Health University of Adelaide, 5000 Adelaide SA, Australia.
  • Spiessens C; Leuven University Fertility Center, UZ Leuven Campus Gasthuisberg, 3000 Leuven, Belgium.
  • De Neubourg D; Leuven University Fertility Center, UZ Leuven Campus Gasthuisberg, 3000 Leuven, Belgium.
  • D'Hooghe TM; Leuven University Fertility Center, UZ Leuven Campus Gasthuisberg, 3000 Leuven, Belgium karen.peeraer@uzleuven.be.
Hum Reprod ; 30(5): 1079-88, 2015 May.
Article en En | MEDLINE | ID: mdl-25788569
ABSTRACT
STUDY QUESTION Can controlled ovarian stimulation with low-dose human menopausal gonadotrophin (hMG) improve the clinical pregnancy rate when compared with ovarian stimulation with clomiphene citrate (CC) in an intrauterine insemination (IUI) programme for subfertile couples? SUMMARY ANSWER Ovarian stimulation with low-dose hMG is superior to CC in IUI cycles with respect to clinical pregnancy rate. WHAT IS KNOWN ALREADY IUI after ovarian stimulation is an effective treatment for mild male subfertility, unexplained subfertility and minimal-mild endometriosis, but it is unclear which medication for ovarian stimulation is more effective. STUDY DESIGN, SIZE, DURATION A total of 330 women scheduled for IUI during 657 cycles (September 2004-December 2011) were enrolled in an open-label randomized clinical trial to ovarian stimulation with low-dose hMG subcutaneous (n = 334, 37.5-75 IU per day) or CC per oral (n = 323, 50 mg/day from Day 3-7). Assuming a difference of 10% in 'clinical pregnancy with positive fetal heart beat', we needed 219 cycles per group (alpha-error 0.05, power 0.80). PARTICIPANTS/MATERIALS, SETTING,

METHODS:

We studied subfertile couples with mild male subfertility, unexplained subfertility or minimal-mild endometriosis. Further inclusion criteria were failure to conceive for ≥12 months, female age ≤42 years, at least one patent Fallopian tube and a total motility count (TMC) ≥5.0 million spermatozoa after capacitation. The primary end-point was clinical pregnancy. Analysis was by intention to treat and controlled for the presence of multiple measures, as one couple could have more randomizations in multiple cycles. Linear mixed models were used for continuous measures. For binary outcomes we estimated the relative risk using a Poisson model with log link and using generalized estimating equations. MAIN RESULTS AND THE ROLE OF CHANCE When compared with ovarian stimulation with CC, hMG stimulation was characterized by a higher clinical pregnancy rate (hMG 48/334 (14.4%) versus CC 29/323 (9.0%), relative risk (RR) 1.6 (95% confidence interval (CI) 1.1-2.4)), higher live birth rate (hMG 46/334 (13.8%) versus CC 28/323 (8.7%), RR 1.6 (95% CI 1.0-2.4)), low and comparable multiple live birth rate (hMG 3/46 (6.5%) versus CC 1/28 (3.6%), P > 0.99), lower number of preovulatory follicles (hMG 1.2 versus CC 1.5, P < 0.001), increased endometrial thickness (hMG 8.5 mm versus CC 7.5 mm, P < 0.001), and a lower cancellation rate per started cycle (hMG 15/322 (4.7%) versus CC 46/298 (15.4%), P < 0.001). LIMITATIONS, REASONS FOR CAUTION We randomized patients at a cycle level, and not at a strategy over multiple cycles. WIDER IMPLICATIONS OF THE

FINDINGS:

This study showed better reproductive outcome after ovarian stimulation with low-dose gonadotrophins. A health economic analysis of our data is planned to test the hypothesis that ovarian stimulation with low-dose hMG combined with IUI is associated with increased cost-effectiveness when compared with ovarian stimulation with CC. STUDY FUNDING/ COMPETING INTERESTS T.M.D. and K.P. were supported by the Clinical Research Foundation of UZ Leuven, Belgium. This study was also supported by the Ferring company (Copenhagen, Denmark) which provide free medication (Menopur) required for the group of patients who were randomized in the hMG COS group. The Ferring company was not involved in the study design, data analysis, writing and submission of the paper. TRIAL REGISTRATION NUMBER NCT01569945 (ClinicalTrials.gov).
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Inducción de la Ovulación / Inseminación Artificial / Clomifeno / Endometriosis / Infertilidad / Menotropinas Tipo de estudio: Clinical_trials / Etiology_studies / Prognostic_studies Límite: Adult / Female / Humans / Male / Pregnancy Idioma: En Revista: Hum Reprod Asunto de la revista: MEDICINA REPRODUTIVA Año: 2015 Tipo del documento: Article País de afiliación: Bélgica

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Inducción de la Ovulación / Inseminación Artificial / Clomifeno / Endometriosis / Infertilidad / Menotropinas Tipo de estudio: Clinical_trials / Etiology_studies / Prognostic_studies Límite: Adult / Female / Humans / Male / Pregnancy Idioma: En Revista: Hum Reprod Asunto de la revista: MEDICINA REPRODUTIVA Año: 2015 Tipo del documento: Article País de afiliación: Bélgica
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