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Related Concept Videos

Infertility in Males01:23

Infertility in Males

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Male infertility affects millions of couples worldwide, arising from various factors that impact different stages of the reproductive process. An endocrine imbalance resulting from conditions like hypogonadism, Klinefelter syndrome, or pituitary disorders can disrupt hormone levels and reduce sperm production. Testicular defects, such as tumors, cryptorchidism, atrophic testes, abnormal sperm morphology, and low sperm count or motility, may arise due to genetic factors, structural...
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In Vitro Fertilization01:24

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In vitro fertilization (IVF) is a form of assisted reproductive technology where an egg is fertilized with sperm in a controlled laboratory environment before transferring the resulting embryo into the uterus. This process is designed to help individuals and couples experiencing difficulties conceiving.
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Infertility in Females01:28

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Female infertility is defined as the inability to conceive after a year of regular, unprotected intercourse and affects about 10–15% of couples worldwide. The primary cause of female infertility is ovulatory disorders, which hinder the release of eggs. These disorders can be classified as hypothalamic amenorrhea, polycystic ovarian syndrome (PCOS), premature ovarian failure, and hyperprolactinemic anovulation disorders.
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IUI for unexplained infertility-a network meta-analysis.

N A Danhof1, R Wang2, M van Wely3

  • 1Center for Reproductive Medicine, AMC, Amsterdam, The Netherlands.

Human Reproduction Update
|December 6, 2019
PubMed
Summary
This summary is machine-generated.

Intrauterine insemination (IUI) with gonadotropins shows higher live birth rates for unexplained infertility but increases multiple pregnancy risks. Strict cancellation criteria in IUI protocols can mitigate these risks while maintaining effectiveness, suggesting gonadotropins with careful monitoring.

Keywords:
IUILetrozoleclomiphene citrategonadotrophinsovarian stimulationunexplained infertility

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Area of Science:

  • Reproductive Medicine
  • Infertility Treatments
  • Evidence-Based Medicine

Background:

  • Intrauterine insemination (IUI) is a treatment for unexplained infertility, performed in natural cycles or with ovarian stimulation.
  • Ovarian stimulation using clomiphene citrate (CC), Letrozole, or gonadotropins increases the risk of multiple pregnancies and associated complications.
  • Previous studies have compared some, but not all, ovarian stimulation agents for IUI in a single analysis.

Purpose of the Study:

  • To conduct a network meta-analysis comparing the effectiveness and safety of IUI with CC, Letrozole, or gonadotropins against each other and natural cycle IUI.
  • To evaluate live birth/ongoing pregnancy rates and multiple pregnancy risks associated with different IUI stimulation protocols.

Main Methods:

  • Systematic search of multiple databases (PubMed, EMBASE, Cochrane, etc.) up to August 2018 for relevant randomized controlled trials.
  • Inclusion of 26 randomized controlled trials involving 5316 women comparing CC, Letrozole, gonadotropins, or natural cycle IUI.
  • Application of a multivariate random effects model for network meta-analysis and pairwise meta-analyses for specific outcomes.

Main Results:

  • Gonadotropin stimulation showed higher live birth/ongoing pregnancy rates compared to CC (RR 1.39) and natural cycles (RR 1.46), with moderate quality evidence.
  • IUI with gonadotropins resulted in a significantly higher risk of multiple pregnancies (RR 9.11) compared to natural cycles.
  • When strict cancellation criteria were applied, gonadotropin stimulation did not compromise effectiveness and showed a trend towards improved live birth rates over CC, with reduced multiple pregnancy risk.

Conclusions:

  • While gonadotropins offer the highest live birth rates for IUI in unexplained infertility, they carry a substantial risk of multiple pregnancies.
  • Implementing strict cancellation criteria in IUI protocols using ovarian stimulation, particularly with gonadotropins, can optimize effectiveness while managing multiple pregnancy rates.
  • The study suggests gonadotropin stimulation within a protocol featuring strict cancellation criteria as a preferred approach for IUI, acknowledging cost and patient preference as additional factors.