IVF; IUI; Diminished Ovarian Reserve
Obtaining adequate numbers of eggs is important when IVF is planned. In spite of our best efforts, often our ovarian stimulation will lead to expectation of fewer eggs than we would consider ideal. In these situations, we must decide whether to proceed to in-vitro fertilization when only 1-3 eggs may be available for aspiration, versus changing plans and converting the treatment plan to intrauterine insemination. Very little data exists concerning which option offers the patient the best prospect for pregnancy. A recent study from Cornell Medical College looked at this question for patients who had either one, two or three mature follicles at the time that the decision for in-vitro fertilization or intra-uterine insemination was made. When two or three follicles were available for aspiration, there appeared to be a significant advantage in terms of improved pregnancy rates when IVF was done rather that intra-uterine insemination. However, when only one follicle was available, IVF did not seem to offer any significant advantage over properly timed intra-uterine insemination. Based on this information, it may be best to counsel patients who have functional fallopian tubes and a partner with acceptable semen parameters to convert the planned IVF cycle to intra-uterine insemination when only one follicle matures.