PCRS Update: IVF vs. IUI when follicle count is three or fewer
IVF vs. IUI when follicle count is three or fewer. How should patients proceed when follicular response falls short of expectation?
At PFC, we treat many women who are unable to conceive on their own due to a decrease in the quantity and quality of eggs in their ovaries, collectively known as Ovarian Reserve. Decreased Ovarian Reserve, DOR, may be a result of the natural irreversible decline that is associated with aging, or due to a genetic predisposition, or a medical condition such as endometriosis. Approximately, one in three patients at PFC suffer from this condition. These patients often require IVF to conceive. A common challenge facing these patients during their IVF cycle is the high risk of poor response to ovarian stimulation hormones. Despite treatment with high doses of injected hormones, the response of ovaries with decreased reserve may only be fewer than three follicles or eggs, while the ovaries of an average patient grow about ten. Because the chance of conception is presumed to be low with fewer than three follicles, patients are often advised to cancel their IVF cycle and switch to intrauterine insemination (IUI) so as to not waste the follicles that have already grown.
This year at PCRS, a poster presentation evaluated pregnancy rates in patients with three or fewer follicles who then went on to undergo either IVF or IUI. Researchers at Cornell University identified over 1000 treatment cycles between 2004 and 2011 where the follicle count was three or fewer. Two thirds of these patients elected to proceed as planned to IVF, where one third opted for IUI. Live birth rates with one follicle were 2.9% with IVF and 2.6% with IUI, which were not statistically different. Live birth rates with two follicles were 8.7% with IVF and 3.4% with IUI, which showed a 2.9-fold statistically significant difference. Live birth rates with three follicles were 11.9% with IVF and 6.6% with IUI, and not statistically different. When combining all cycles with three or fewer follicles, the overall live birth rates were 9.3% with IVF and 3.4% with IUI, a 2.6-fold statistically significant difference.
- Liyun Li, MD