Superovulation and timed intercourse: can it provide a reasonable alternative for those unable to afford assisted conception?

Superovulation was performed prospectively with pure follicle stimulating hormone (FSH) to a group of 224 infertile patients with ovulatory factor (51), male factor (60), mild/moderate endometriosis (24) and unexplained infertility (72). The aim was to produce three or four leading follicles in order to compensate for a 'deficient' factor. Ovulation was induced with human chorionic gonadotrophin (HCG) and monitoring was performed entirely by serial transvaginal ultrasound on alternate cycles up to a maximum of six cycles (1120 treatment cycles) with intervening cycles being used as self-controls (932 rest cycles). A further control group of 56 patients was matched for age, category and duration of infertility and was only scanned serially (336 control cycles). Seventy-four pregnancies were achieved and 54 delivered, giving a cumulative pregnancy rate per couple of 33% and a cumulative take home baby rate of 24% per couple after a maximum of six cycles of treatment. When compared with the rest or control cycles, treatment was significantly effective for ovulatory (P < 0.001), mild/moderate endometriosis (P < 0.01) and unexplained infertility (P < 0.01) but not for male infertility. Furthermore, pregnancy was five times more likely during the first four treatment cycles (P = 0.00006, odds ratio = 5) at the expense of a significant multiple pregnancy rate (18.9%) and mild/moderate ovarian hyperstimulation rate (12%). We conclude that four cycles of superovulation should be routinely offered to couples on waiting lists for assisted conception or to those unable to afford it, in anovulatory, mild/moderate endometriosis and unexplained infertility. These results need confirmation by a prospective multi-centre randomized study.