A randomized clinical trial to evaluate optimal treatment for unexplained infertility: the fast track and standard treatment (FASTT) trial

Objective: To determine the value of gonadotropin/ intrauterine insemination (FSH/IUI) therapy for infertile women aged 21-39 years. Design: Randomized controlled trial. Setting: Academic medical center associated with a private infertility center. Patient(s): Couples with unexplained infertility. Intervention(s): Couples were randomized to receive either conventional treatment (n = 247) with three cycles of clomiphene citrate (CC)/IUI, three cycles of FSH/IUI, and up to six cycles of IVF or an accelerated treatment (n 256) that omitted the three cycles of FSH/IUI. Main Outcome Measure(s): The time it took to establish a pregnancy that led to a live birth and cost-effectiveness, defined as the ratio of the sum of all health insurance charges between randomization and delivery divided by the number of couples delivering at least one live-born baby. Result(s): An increased rate of pregnancy was observed in the accelerated arm (hazard ratio [HR], 1.25; 95% confidence interval [CI], 1.00-1.56) compared with the conventional arm. Median time to pregnancy was 8 and 11 months in the accelerated and conventional arms, respectively. Per cycle pregnancy rates for CC/IUI, FSH/IUI, and IVF were 7.6%, 9.8%, and 30.7%, respectively. Average charges per delivery were $9,800 lower (95% CI, $25,100 lower to $3,900 higher) in the accelerated arm compared to conventional treatment. The observed incremental difference was a savings of $2,624 per couple for accelerated treatment and 0.06 more deliveries. Conclusion(s): A randomized clinical trial demonstrated that FSH/IUI treatment was of no added value. (Fertil Steril (R) 2010; 94: 888-99. (c) 2010 by American Society for Reproductive Medicine.)