A Cochrane review [Abstract] 1 included 15 trials involving a total of 2 068 women.
It was uncertain whether treatment with intra-uterine insemination (IUI) in a natural cycle improved live birth rate compared to treatment with expectant management (OR 1.60, 95% CI 0.92 to 2.78; 1 RCT, n=334), or IUI in a stimulated cycle improved live birth rates compared to treatment with timed intercourse (TI) in a stimulated cycle (OR 1.59, 95% CI 0.88 to 2.88; 2 RCTs, n=208). IUI combined with clomiphene citrate or letrozole resulted in a higher live birth rate compared to treatment with expectant management in a natural cycle (OR 4.48, 95% CI 2.00 to 10.01; 1 RCT; n=201). IUI in a natural cycle resulted in a higher cumulative live birth rate compared to treatment with expectant management in a stimulated cycle (OR 1.95, 95% CI 1.10 to 3.44; 1 RCT, n=342). IUI in a stimulated cycle resulted in a higher cumulative live birth rate compared to treatment with IUI in a natural cycle (OR 2.07, 95% CI 1.22 to 3.50; 4 RCTs, n=396).
Another Cacrane review [Abstract] and a network meta-analysis 2 included 24 RCTs with 3 983 couples. Ten RCTs including 2 725 couples reported on live birth. For differences between OS, IUI, OS-IUI, or vitro fertilisation with or without intracytoplasmic (IVF/ICSI) versus expectant management see table (tableT1). This suggests that if the chance of live birth following expectant management is assumed to be 17%, the chance following OS, IUI, OS-IUI, and IVF would be 9% to 28%, 11% to 33%, 15% to 37%, and 14% to 47%, respectively. When only including couples with poor prognosis of natural conception (3 trials, 725 couples) OS‐IUI and IVF/ICSI increased LBR compared to expectant management (OR 4.48, 95% CI 2.00 to 10.1; moderate-certainty evidence; OR 4.99, 95 CI 2.07 to 12.04; moderate-certainty evidence), while there was insufficient evidence of a difference between IVF/ICSI and OS-IUI (OR 1.11, 95% CI 0.78 to 1.60; low-certainty evidence).Compared to expectant management, other treatments increased the odds of multiple pregnancy (11 RCTs, 2564 couples).
An open-label, randomised, controlled, two-centre trial 3 included 201 women with unexplained infertility. Women assigned to IUI had a higher cumulative livebirth rate than women assigned to expectant management (31% livebirths vs 9% livebirths; RR 3.41, 95% CI 1.71 to 6.79; p=0.0003).
| Outcome: Live birth rate or ongoing pregnancy | Assumed riskwith comparatorExpectant management | Risk with intervention | Relative effect(95% CI) | Numbe of couples (Studies)Quality of evidence |
|---|---|---|---|---|
| 166 per 1000 | OS 167 per 1000(92 to 282) | OR 1.01(0.51 to 1.98) | 527 (2)Low | |
| 166 per 1000 | IUI 194 per 1000(108 to 325) | OR 1.45(0.61 to 2.43) | 386 (1) Low | |
| 166 per 1000 | OS-IUI 242 per 1000(149 to 369) | OR 1.61(0.88 to 2.94) | 454 (2) Low | |
| 166 per 1000 | IVF/ICSI272 per 1000(139 to 465) | OR 1.88(0.81 to 4.38) | only indirect evidence used hereLow |
Comment: The quality of evidence is downgraded by study quality (unclear allocation concealment) and by imprecise results (limited study size for each comparison).
Primary/Secondary Keywords