Controlled ovarian hyperstimulation (COH) uses fertility medication to mature greater than one egg per month. By maturing multiple eggs in a given month you increase the number of “targets” for available sperm. The use of COH/IUI is a widely accepted approach of moderate level aggressiveness for mild to moderate male factor infertility, unexplained infertility and ovulatory dysfunctions resistant to (or intolerant to) clomiphene citrate.
The literature regarding the use of these techniques is not abundant, but does suggest
- for male factor infertility or couples with an abnormal postcoital test, menotropins with IUI increase the pregnancy rate up to 4 fold over no treatment, to a success rate of 10-15% per cycle for male factor and slightly higher for those with only an abnormal postcoital test;
- for unexplained infertility the per cycle success rates in one study are about 3% for IUI alone, 6% for menotropins alone, and 26% for menotropins with IUI; and
- clomid, menotropins or IUI alone are relatively ineffective in the treatment of male factor or unexplained infertility
When the sperm quality is not adequate to recommend COH/IUI, or if this management has not resulted in pregnancy within a reasonable trial period (3-6 cycles with good apparent multiple egg development) then alternative treatment plans should be considered.