A Cochrane review [Abstract] 1 included 9 studies involving a total of 2191 subjects. Live-birth rates (LBR) per woman was higher with in vitro fertilisation (IVF) (45.8%) than expectant management (3.7%) (OR 22.00; 95% CI 2.56 to 189.37; 1 RCT, n=51). In studies comparing IVF versus ovarian stimulation plus intrauterine insemination (OS-IUI), LBR per woman did not differ significantly between the groups. Assuming 42% LBR with IUI + gonadotropins (1 IVF to 2 to 3 IUI cycles) and 26% LBR with IUI + gonadotropins (1 IVF to 1 IUI cycle), LBR would be 39% to 54% and 24% to 51% with IVF. There was no evidence of a significant difference in multiple pregnancy rate or ovarian hyperstimulation syndrome between the two treatments.
Another Cochrane review [Abstract] and a network meta-analysis 2 included 27 RCTs with 4 349 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 (table T1). 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).
| 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 certainty of the evidence is downgraded by risk of bias (no blinding).
Primary/Secondary Keywords