ArticleF&S reports2025
The impact of expectant management compared with intrauterine insemination with ovarian stimulation on quality of life and coital frequency in couples with unexplained subfertility.
Article in F&S reports, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Objective: To study the impact of 6 months of expectant management (EM) compared with 6 months of intrauterine insemination with ovarian stimulation (IUI-OS) on the health-related quality of life (HRQoL), anxiety and depression scores and the coital frequency in couples with unexplained subfertility and a poor prognosis for natural conception. Design: A study alongside the ExIUI trial, a multicentre randomized controlled trial. Subjects: Couples with unexplained subfertility and a poor prognosis for natural conception based on the score of Hunault. Intervention: Women in both groups were asked to fill in the Fertility Quality of Life (FertiQol) and Hospital Anxiety and Depression Scale (HADS) questionnaires at 3 moments and to keep a diary with their periods and dates of coitus. Main Outcome Measures: Health-related quality of life scores, anxiety and depression scores, and coital frequency. Results: Of the 178 women, 161 (90%) filled in at least one questionnaire. Women allocated to EM scored significantly lower on the relational domain compared with women allocated to IUI-OS (overall mean difference, -5.93; 95% confidence interval [CI], -10.64 to -1.22). We found no difference between the two groups in the social domain (overall mean difference, -4.72; 95% CI, -9.88 to 0.45). No difference between the two was found in anxiety (overall mean difference, -0.20; 95% CI, -1.44 to 1.04) or depression scores (overall mean difference, 0.22; 95%CI, -0.86 to 1.30). Among all women allocated to either EM or IUI-OS, anxiety and depression scores increased over time. Seventy-nine (44%) out of 178 women filled in at least one month of their diary and reported on a total of 497 cycles and registered 2,026 dates of coitus. The median coital frequency per cycle was 4 (interquartile range [IQR]: 1-7) in the EM group and 3 (IQR: 0-7) in the IUI-OS group. The median coital frequency in the fertile window per cycle was 2 (IQR: 0-3) in EM and 1 (IQR: 0-3) in IUI-OS, which was a statistically significant difference. Conclusion: Compared with IUI-OS, 6 months of EM resulted in a lower HRQoL on the relational domain, comparable anxiety and depression scores and higher coital frequency in the fertile window. Clinical Trial Registration Number: Dutch Trial register NL5455 (NTR5599).
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