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Intra-uterine insemination for unexplained subfertility.

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Area of Science:

  • Reproductive Medicine
  • Infertility Treatments
  • Evidence-Based Medicine

Background:

  • Intra-uterine insemination (IUI) is a common fertility treatment for unexplained subfertility.
  • The safety and efficacy of IUI combined with ovarian hyperstimulation (OH) are debated, particularly concerning multiple pregnancy rates.

Purpose of the Study:

  • To evaluate if IUI with or without OH improves live birth rates compared to timed intercourse (TI) or expectant management.
  • To compare IUI with OH against IUI in a natural cycle for unexplained subfertility.

Main Methods:

  • A systematic review of randomized controlled trials (RCTs) was conducted.
  • Searches included major databases up to October 2019.
  • Data extraction and quality assessment were performed independently by two reviewers.

Main Results:

  • Evidence quality ranged from very low to moderate, with significant imprecision.
  • IUI with OH likely increases live birth rates compared to expectant management in low-conception-risk couples.
  • IUI in a natural cycle may offer higher live birth rates than stimulated expectant management.

Conclusions:

  • Insufficient data exists to definitively conclude if IUI with or without OH improves live birth rates with acceptable multiple pregnancy rates.
  • IUI with OH appears beneficial for specific subgroups, but more research is essential.
  • IUI in a natural cycle may be more effective than stimulated expectant management.