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Meta-Analysis
. 2013 Oct 30;2013(10):CD001502.
doi: 10.1002/14651858.CD001502.pub4.

Intrauterine insemination versus fallopian tube sperm perfusion for non-tubal infertility

Astrid E P Cantineau  1 , Ben J Cohlen, Maas Jan Heineman, Jane Marjoribanks, Cindy Farquhar
Affiliations
Meta-Analysis

Intrauterine insemination versus fallopian tube sperm perfusion for non-tubal infertility

Astrid E P Cantineau et al. Cochrane Database Syst Rev. .

Abstract

Background: Intrauterine insemination (IUI) is a common treatment for couples with subfertility that does not involve the fallopian tubes. It is used to bring the sperm close to the released oocyte. Another method of introducing sperm is fallopian tube sperm perfusion (FSP). Fallopian tube sperm perfusion ensures the presence of higher sperm densities in the fallopian tubes at the time of ovulation than does standard IUI. These treatments are often used in combination with ovarian hyperstimulation.

Objectives: To compare intrauterine insemination versus fallopian tube sperm perfusion in the treatment of non-tubal subfertility, for live birth and pregnancy outcomes.

Search methods: We searched the Menstrual Disorders and Subfertility Group Trials Register, MEDLINE, CINAHL and EMBASE from inception to September 2013. We also searched study reference lists and trial registers.

Selection criteria: Randomised controlled trials (RCTs) comparing IUI with FSP in couples with non-tubal subfertility were included.

Data collection and analysis: Two review authors independently selected studies for inclusion, assessed study quality and extracted the data. If studies were sufficiently similar, data were combined using a fixed-effect model to calculate pooled odds ratios (ORs) and 95% confidence intervals (CIs). A random-effects model was used if substantial statistical heterogeneity was detected. Studies that included participants with unexplained or mixed (non-tubal) subfertility were analysed separately from studies restricted to participants with mild or moderate male factor subfertility. The overall quality of evidence for the main outcomes was summarised using Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria.

Main results: The review included 16 RCTs. Fourteen RCTs (1745 women) were included in the meta-analysis. Only three studies reported live birth per couple. No evidence of a statistically significant difference was noted between IUI and FSP in live birth (OR 0.94, 95% CI 0.59 to 1.49, three RCTs, 633 women, I(2) = 0%, low-quality evidence) or clinical pregnancy (OR 0.75, 95% CI 0.49 to 1.12, 14 RCTs, 1745 women, I(2) = 52%, low-quality evidence). These findings suggest that for a couple with a 13% chance of live birth using FSP, the chance when using IUI will be between 8% and 19%; and that for a couple with a 19% chance of pregnancy using FSP, the chance of pregnancy when using IUI will be between 10% and 20%. Nor was evidence found of a statistically significant difference between IUI and FSP in per-pregnancy of multiple pregnancy (OR 0.96, 95% CI 0.44 to 2.07, eight RCTs, 197 women, I(2) = 0%, low-quality evidence), miscarriage (OR 1.23, 95% CI 0.60 to 2.53, seven RCTs, 199 women, I(2) = 0%, low-quality evidence) or ectopic pregnancy (OR 1.71, 95% CI 0.42 to 6.88, four RCTs, 111 women, I(2) = 0%, very low quality evidence). Substantial heterogeneity was noted for the outcome of clinical pregnancy (I(2) = 54%), for which no clear explanation was provided.

Authors' conclusions: Currently no clear evidence suggests any difference between IUI and FSP with respect to their effectiveness and safety for treating couples with non-tubal subfertility. However, a high level of uncertainty is evident in the findings, and additional research may be useful.

PubMed Disclaimer

Conflict of interest statement

Cindy Farquar is principal investigator of one of the included studies (Farquhar 2013).

Figures

1
1
Study flow diagram.
2
2
Methodological quality graph: review authors' judgements about all methodological quality items presented as percentages across all included studies.
3
3
Methodological quality summary: review authors' judgements about all methodological quality items for each included study.
4
4
Forest plot of comparison: 1 NEW Intrauterine insemination versus fallopian tube sperm perfusion, outcome: 1.1 Live birth per couple.
5
5
Forest plot of comparison: 1 IUI vs FSP: unexplained or mixed (non‐tubal) causes, outcome: 1.2 Clinical pregnancy per couple (unexplained and mixed causes).
6
6
Funnel plot of comparison: 1 IUI versus FSP, outcome: 1.2 Clinical pregnancy per couple.
1.1
1.1. Analysis
Comparison 1 IUI versus FSP, Outcome 1 Live birth per couple.
1.2
1.2. Analysis
Comparison 1 IUI versus FSP, Outcome 2 Clinical pregnancy per couple.
1.3
1.3. Analysis
Comparison 1 IUI versus FSP, Outcome 3 Multiple pregnancy.
1.4
1.4. Analysis
Comparison 1 IUI versus FSP, Outcome 4 Miscarriage rate.
1.5
1.5. Analysis
Comparison 1 IUI versus FSP, Outcome 5 Ectopic pregnancy.
2.1
2.1. Analysis
Comparison 2 IUI versus FSP subgroups by indication, Outcome 1 Unexplained subfertility.
2.2
2.2. Analysis
Comparison 2 IUI versus FSP subgroups by indication, Outcome 2 Mild to moderate male factor subfertility.
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References

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