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Intra-uterine insemination for unexplained subfertilityVerhulst SM, Cohlen BJ, Hughes E, te Velde E, Heineman MJ
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SummaryThere is evidence that intra-uterine insemination (IUI) improves the odds of becoming pregnant for couples with unexplained subfertility compared to timed intercourse. The addition of fertility drugs to IUI treatment to induce ovulation also improves the chances.IUI is a treatment often used for couples with unexplained subfertility. In an IUI cycle, the male partner's sperm is prepared and placed directly in the uterus at the time of ovulation. IUI cycles can be used in combination with fertility drugs to stimulate the ovaries and increase the number of available eggs. However, these drugs can have adverse effects and also increases the risk of multiple pregnancies. The review of trials found some evidence that IUI increases the chance of pregnancy compared with ensuring correct timing of intercourse. There was also evidence of an increased live birth rate in women who underwent IUI and who were also given fertility drugs to stimulate the ovaries. However, increased multiple pregnancy rates are concerning and further studies are needed to assess the magnitude of this problem.
This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2008 Issue 3, Copyright © 2008 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
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October 18. 2006 AbstractBackgroundIntra-uterine insemination (IUI) is a widely used fertility treatment for couples with unexplained subfertility. Although IUI is less invasive and less expensive than in vitro fertilisation (IVF), the safety of IUI in combination with ovarian hyperstimulation (OH) is debated. The main concern about IUI treatment with OH is the increase in multiple pregnancy rate. ObjectivesTo determine whether for couples with unexplained subfertility IUI improves the live birth rate compared with timed intercourse (TI), both with and without ovarian hyperstimulation. Search strategyWe searched the Cochrane Menstrual Disorder and Subfertility Group Trials Register (searched March 2005), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2005, Issue 4), MEDLINE (1966 to November 2005), EMBASE (1980 to November 2005), SCIsearch and reference lists of articles. Authors of identified studies were contacted for missing or unpublished data. Selection criteriaTruly randomised controlled trials (RCTs) with at least one of the following comparisons were included: Data collection and analysisQuality assessment and data extraction were performed independently by two review authors. Outcomes were extracted and the data were pooled. Subgroup and sensitivity analyses were done where possible. Main resultsIn the six trials where IUI was compared with TI both in stimulated cycles, there was evidence of an increased chance of pregnancy (six RCTs, 517 women: OR 1.68, 95% CI 1.13 to 2.50). A significant increase in live birth rate was found for women where IUI with OH was compared with IUI in natural cycle (four RCTs, 396 women: OR 2.07, 95% CI 1.22 to 3.50). However the trials provided insufficient data to investigate the impact of IUI with or without OH on several important outcomes including live birth, multiple pregnancies, miscarriage and risk of ovarian hyperstimulation. There was no evidence of a difference in pregnancy rate for IUI with OH compared with TI in natural cycle (one RCT, 51 women: OR 4.05, 95% CI 0.39 to 41.87). No RCTs were found for the other two comparisons. Authors' conclusionsThere is evidence that IUI with OH increases the live birth rate compared to IUI alone. The likelihood of pregnancy was also increased for treatment with IUI compared to TI both in stimulated cycles. There is insufficient data on multiple pregnancies and other adverse events for treatment with OH. Therefore couples should be fully informed about the risks of IUI and OH as well as alternative treatment options. |