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Intrauterine insemination + controlled ovarian hyperstimulation versus in vitro fertilisation in unexplained infertility: a systematic review and meta-analysis

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Abstract

Background

IUI + COH is widely used in cases of unexplained infertility before resorting to IVF. Debate continues about what should be the first-line treatment for couples with unexplained infertility.

Objectives

This systematic review assessed the relative efficacy of IUI + COH compared with IVF in couples with unexplained infertility.

Search strategy

We searched Medline, Embase, CIHNL, Pscy Info, and Cochrane Library from 1980 to November 2019.

Selection criteria

Only RCTs published articles in full text with female patients aged 18–43 years and diagnosed with unexplained infertility were included.

Data collection and analysis

Two authors reviewed citations from primary search independently and any disagreement was resolved by mutual discussion and consultation with a third author.

Main result

In total, eight RCTs were included. The quality of evidence was moderate to low due to inconsistency across the trials and imprecision. The pooled result showed that IVF was associated with a statistically significant higher live birth rate (RR 1.53, 95% CI 1.01–2.32, P < 0.00001 I2 = 86%) with no significant difference in multiple pregnancy rate or OHSS rate. Sensitivity analysis based on women’s age and a history of previous IUI or IVF treatment showed no significant difference in the live birth rates (RR 1.01, 95% CI 0.88–1.15, I2 = 0%, 3 RCTs) in treatment-naïve women younger than 38 years. In women over 38 years, the live birth rates were significantly higher in the IVF group (RR 2.15, 95% CI 1.16–4.0, I2 = 42%, 1 RCT).

Conclusion

Further research using a standardised treatment protocol and taking into account important prognostic variables and cumulative live birth rates from fresh IVF and all sibling frozen embryos is required to further guide clinical practice.

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Funding

There has been no external funding for this review.

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Authors and Affiliations

  1. Assisted Conception Unit, Great Maze Pond, Guy’s and St Thomas’ Hospital NHS Trust, London, SE1 9RT, UK

    Anupa Nandi, Davinia White & El-Toukhy Tarek

  2. Department of Obstetrics and Gynaecology, Watford General Hospital, Hertfordshire, UK

    Gangopadhyay Raja

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  1. Anupa Nandi
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  2. Gangopadhyay Raja
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Contributions

AN and GR contributed by designing the study, literature review, data collection and analysis and writing the manuscript. TET reviewed the data analysis and the final manuscript. DW contributed by providing expert opinion after reviewing the final manuscript.

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Correspondence to Anupa Nandi.

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Nandi, A., Raja, G., White, D. et al. Intrauterine insemination + controlled ovarian hyperstimulation versus in vitro fertilisation in unexplained infertility: a systematic review and meta-analysis. Arch Gynecol Obstet 305, 805–824 (2022). https://doi.org/10.1007/s00404-021-06277-3

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