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Related Experiment Videos

Intra-uterine insemination for unexplained subfertility.

S M Verhulst1, B J Cohlen, E Hughes

  • 1Rijksuniversiteit Groningen, Vijverlaan 4, Rotterdam, Netherlands. s.verhulst@wherever.nl

The Cochrane Database of Systematic Reviews
|October 21, 2006
PubMed
Summary
This summary is machine-generated.

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Intra-uterine insemination (IUI) with ovarian hyperstimulation (OH) increases live birth rates compared to IUI alone for unexplained subfertility. However, insufficient data exists on risks like multiple pregnancies, necessitating informed patient choices.

Area of Science:

  • Reproductive Medicine and Assisted Reproductive Technologies (ART)
  • Clinical Obstetrics and Gynecology
  • Evidence-Based Medicine and Systematic Reviews

Background:

  • Intra-uterine insemination (IUI) is a common fertility treatment for unexplained subfertility.
  • The safety of combining IUI with ovarian hyperstimulation (OH) is debated, primarily due to concerns about increased multiple pregnancy rates.
  • In vitro fertilisation (IVF) is a more invasive and expensive alternative.

Purpose of the Study:

  • To evaluate if IUI improves live birth rates compared to timed intercourse (TI) for unexplained subfertility.
  • To assess the effectiveness of IUI with and without OH in comparison to TI.

Main Methods:

  • Systematic review of randomized controlled trials (RCTs) identified through comprehensive database searches (Cochrane, MEDLINE, EMBASE) up to November 2005.

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  • Inclusion criteria focused on unexplained subfertility and specific comparisons: IUI vs. TI (natural/stimulated cycles), IUI (natural vs. stimulated), IUI with OH vs. TI (natural cycle), IUI (natural cycle) vs. TI with OH.
  • Independent quality assessment and data extraction by two authors; pooled data analysis with subgroup and sensitivity analyses.

    • Main Results:

    • IUI in stimulated cycles showed an increased pregnancy chance compared to TI (OR 1.68, 95% CI 1.13 to 2.50).
    • IUI with OH significantly increased pregnancy rates compared to IUI in a natural cycle (OR 2.33, 95% CI 1.46 to 3.71).
    • Insufficient data prevented analysis of live birth rates, multiple pregnancies, miscarriage, and OH risks. No significant difference in pregnancy rates was found for IUI with OH vs. TI in a natural cycle (OR 4.05, 95% CI 0.39 to 41.87).

    Conclusions:

    • Evidence suggests IUI with OH improves live birth rates over IUI alone and increases pregnancy likelihood compared to TI in stimulated cycles.
    • Crucially, data on adverse events, including multiple pregnancies and OH risks, remains insufficient.
    • Informed counseling regarding IUI, OH risks, and alternative treatments is essential for couples undergoing fertility treatment.