Conversion from assisted reproductive technology to intrauterine insemination in low responders: Is it advantageous?

Objective: To examine cycle outcomes among patients demonstrating an attenuated ovarian response that proceeded to oocyte retrieval to those converted to intrauterine insemination (IUI). Design: Retrospective cohort study. Setting: Large private fertility center. Patient(s): First planned autologous assisted reproductive technology (ART) cycles among women demonstrating a poor ovarian response to hyperstimulation (<= 4 follicles >= 14 mm, peak E-2 <1,000 IU/L at hCG administration). Intervention(s): Oocyte retrieval or IUI conversion. Main Outcome Measure(s): Live birth and clinical pregnancy. Result(s): A total of 269 IUI conversions and 167 oocyte retrievals followed a poor ovarian response to gonadotropins among first planned ART cycles. Number of follicles >= 14 mm (2.3 vs. 3.5) and peak E-2 levels (555 vs. 743 pg/mL) were lower for IUI conversions compared with those proceeding to ART. Peak E-2 was similar between groups after adjusting for follicle number (IUI: 611 pg/mL; ART: 652 pg/mL). Stimulation response was similar between treatment groups with equivalent follicle numbers. Undergoing oocyte retrieval was associated with significantly improved pregnancy (odds ratio [OR] 3.6, 95% confidence interval [CI] 1.8-7.4) and live birth outcome (OR 3.5, 95% CI 1.7-8.0) after adjusting for age and follicle number. Conclusion(s): Among women demonstrating a poor ovarian response to gonadotropins, proceeding with planned ART resulted in significantly higher pregnancy rates than converting these cycles to IUI. (Fertil Steril (R) 2010; 94: 2073-7. (C) 2010 by American Society for Reproductive Medicine.)