Results of in vitro fertilization versus intrauterine insemination in patients with low anti-Müllerian hormone levels. A single-center retrospective study of 639 + 119 cycles - 31/07/20

Doi : 10.1016/j.jogoh.2020.101874

Clémence Sapet ^a,^b,⁎ , Antoine Gavoille ^b,^c, Alix Sesques ^a, Thomas Freour ^d, Fabien Subtil ^e, Bruno Salle ^a,^b
^a Hospices Civils de Lyon, Service de médecine de la reproduction, Hopital Femme Mère Enfant, 59 Boulevard Pinel, 69500 Bron, France
^b Université Claude Bernard Lyon 1, 43 Boulevard du 11 Novembre 1918, 69100 Villeurbanne, France
^c Hospices civils de Lyon, Service de Biostatistique-Bioinformatique, Lyon, France
^d Service de médecine et biologie de la reproduction, hôpital Mère et Enfant, CHU de Nantes, 38, boulevard Jean-Monnet, 44093 Nantes cedex 1, France
^e Université de Lyon, Université Lyon 1, CNRS, Laboratoire de Biométrie et Biologie Évolutive UMR 5558, Villeurbanne, France

^⁎Corresponding author at: 20 Rue Bodin, 69001 Lyon, France.20 Rue BodinLyon69001France

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Abstract

Objectives

The aim of this study was to evaluate the results of in vitro fertilization (IVF) and intrauterine insemination (IUI) in a population of infertile women with low AMH levels, in whom both techniques were possible.

Methods

This was a retrospective analysis of 462 patients treated over 24 months in a single center comparing the live birth rates after 176 IUI and 639 IVF attempts in infertile couples. The women had AMH levels ≤ 1.2 ng/mL and at least one patent tube and their partner’s sperm was of sufficient quality for IUI.

Results

The live birth rate after IVF was not sufficiently higher than after IUI, or than after IVF attempts converted to IUI for low response (odds ratios in multivariate analysis with respect to IVF: 0.61, p = 0.15 for IUI and 0.73, p = 0.6 for conversions). The pregnancy rates after IVF (13.0 %) and IUI (13.3 %) were similar (p = 0.4), and were non-significantly higher than the pregnancy rate in the IUI conversion group (8.8 %, p = 0.9). Nearly half (43.8 %) of all IVF cycles did not lead to embryo transfer.

Conclusion

In this group of women with AMH levels ≤ 1.2 ng/mL, IVF did not lead to a higher live birth rate than IUI, and more than 40 % of all IVF attempts did not lead to embryo transfer, suggesting that diminished ovarian reserve is not an indication for IVF over IUI.

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Keywords : Anti-Müllerian hormone, Infertility, Intrauterine insemination, In-vitro fertilisation, Live birth rate, Poor responder