Assisted reproductive technologies for male subfertility

Area of Science:

• Reproductive Medicine
• Infertility Research
• Clinical Trials

Background:

• Male subfertility affects many couples seeking fertility treatments.
• Intra-uterine insemination (IUI), in vitro fertilisation (IVF), and intracytoplasmic sperm injection (ICSI) are common but their effectiveness for male subfertility is debated.
• Limited knowledge exists on the efficacy of various treatments across different severities of male subfertility.

Purpose of the Study:

• To evaluate the effectiveness and safety of fertility treatments for male subfertility.
• Comparisons include expectant management, timed intercourse (TI), IUI, IVF, and ICSI.
• Focus is on couples with abnormal sperm parameters.

Main Methods:

• Systematic review of randomised controlled trials (RCTs).
• Comprehensive database searches (Cochrane, MEDLINE, EMBASE, etc.) up to April 2015.
• Inclusion of RCTs comparing different treatments for male subfertility in couples with abnormal sperm parameters.

Main Results:

• The review included 10 RCTs with 757 couples; evidence quality was consistently low or very low.
• No significant differences were found in live birth or pregnancy rates between IUI, TI, and IVF.
• Insufficient data prevented definitive conclusions on safety, including ovarian hyperstimulation syndrome (OHSS).

Conclusions:

• There is insufficient evidence to determine the comparative safety and effectiveness of different fertility treatments for male subfertility.
• Further high-quality research, particularly RCTs, is necessary to guide clinical practice.
• Couples may be undergoing unnecessary or ineffective treatments due to limited evidence.