Poor Responders to IVF: Convert to IUI or Stick with ART?

Finding out that you're a 'poor responder' is part of the IVF rollercoaster for many women. After completing weeks of invasive testing and self-injecting one or more medications daily, poor responders are stressed to see that only a small handful of follicles (if that many) are maturing in response to the stimulation medication. Depending on her history, her doctor's preferences and other factors, the "go/no go" decision needs to be made.

The question becomes: do you continue with IVF, knowing only a few eggs will be retrieved, or do you convert the cycle to an IUI (intrauterine insemination) cycle, to try and maximize the chances of fertilization while significantly cutting the cycle's costs.

A study published in Fertility and Sterility looked at this issue to see which method - continuing with IVF or converting to an IUI cycle - would have the greatest likelihood of success. They looked at the cycles of 436 women who were poor responders: 269 of which were converted to IUI and 167 of which proceeded to retrieval and a continuation of the IVF cycle. In this study, Dr. Norian and his team from Shady Grove Fertility Reproductive Sciences Center found that continuing with the IVF cycle resulted in significantly higher pregnancy and live birth rates than cycles that converted to an IUI procedure.

However, the likelihood of success drops significantly when only one follicle is present; in this case the study's authors could only recommend cancellation (but did not study the effects of cancellation with timed intercourse).

Source: John M. Norian, M.D., Eric D. Levens, M.D., Michael J. Levy, M.D., Kevin S. Richter, Ph.D., and Eric A. Widra, M.D. Conversion from assisted reproductive technology to intrauterine insemination in low responders: is it advantageous? Fertility & Sterility. 2010 November; 94(6): 2073–2077.