IUI compared to TI or expectant management both in natural cycle for unexplained subfertility

Patient or population: participants with unexplained subfertility
Settings: fertility clinic
Intervention: IUI
Comparison: TI or expectant management both in natural cycle

Live birth rates per couple (all cycles)

OR 1.60
(0.92 to 2.78)

334
(1 study)

⊕⊕⊝⊝
low^a

‐

Multiple pregnancy rate per couple

OR 0.50
(0.04 to 5.53)

334
(1 study)

⊕⊕⊝⊝
low^a

‐

Pregnancy rate per couple (all cycles)

OR 1.53
(0.88 to 2.64)

334
(1 study)

⊕⊕⊝⊝
low^a

‐

Ovarian hyperstimulation syndrome rate per woman ‐ not reported

‐

‐

See comment

No data reported on outcome

Miscarriage rate per couple

OR 0.77
(0.28 to 2.11)

334
(1 study)

⊕⊕⊝⊝
low^a

‐

Ectopic pregnancy rate per couple

OR 05.06
(0.24 to 1106.21)

334
(1 study)

⊕⊕⊝⊝
low^a

‐

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; OR: Odds ratio;

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

IUI compared to TI or expectant management both in stimulated cycle for unexplained subfertility

Patient or population: participants with unexplained subfertility
Settings: fertility clinic
Intervention: IUI
Comparison: TI or expectant management both in stimulated cycles

Live birth rate per couple (all cycles)

OR 1.59
(0.88 to 2.88)

208
(2 studies)

⊕⊕⊝⊝
low^a

‐

Multiple pregnancy rate per couple

OR 1.46
(0.55 to 3.87)

316
(4 studies)

⊕⊕⊝⊝
low^a

‐

Pregnancy rate per couple (all cycles)

OR 1.69
(1.14 to 2.53)

517
(6 studies)

⊕⊕⊝⊝
low^b,c

‐

Ovarian hyperstimulation syndrome rate per woman

OR 2.75
(0.11 to 69.83)

68
(1 study)

⊕⊝⊝⊝
very low^a,b

‐

Miscarriage rate per couple

OR 1.66
(0.56 to 4.88)

208
(2 studies)

⊕⊕⊝⊝
low^a

‐

Ectopic pregnancy rate per couple

OR 3.06
(0.12 to 76.95)

100
(1 study)

⊕⊕⊝⊝
low^a

‐

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; OR: Odds ratio;

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

IUI in stimulated cycle compared to TI or expectant management in natural cycle for unexplained subfertility

Patient or population: participants with unexplained subfertility
Settings: fertility clinic
Intervention: IUI in stimulated cycle
Comparison: TI or expectant management in natural cycle

Live birth rate per couple (all cycles)‐ clomiphene citrate or letrozole

OR 4.48
(2 to 10.01)

201
(1 study)

⊕⊕⊕⊝
moderate^a

‐

Live birth rate per couple (all cycles)‐ clomiphene citrate or gonadotropins

OR 0.82
(0.45 to 1.49)

253
(1 study)

⊕⊕⊝⊝
low^b

‐

Multiple pregnancy rate per couple

OR 3.01
(0.47 to 19.28)

454
(2 studies)

⊕⊕⊝⊝
low^b

‐

Pregnancy rate per couple (all cycles)‐ clomiphene citrate or letrozole

OR 4.68
(2.22 to 9.86)

201
(1 study)

⊕⊕⊕⊝
moderate^a

‐

Ovarian hyperstimulation syndrome rate per woman

See comment

See comment

See comment

No events in intervention or control groups

Miscarriage rate per couple

OR 2.87
(1.18 to 7.01)

454
(2 studies)

⊕⊕⊕⊝
moderate^a

‐

Ectopic pregnancy rate per couple

OR 9.28
(0.49 to 174.6)

201
(1 study)

⊕⊕⊝⊝
low^b

‐

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; OR: Odds ratio;

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

IUI in natural cycle compared to TI or expectant management in stimulated cycle for unexplained subfertility

Patient or population: participants with unexplained subfertility
Settings: fertility clinic
Intervention: IUI in natural cycle
Comparison: TI or expectant management in stimulated cycle

Live birth rate per couple (all cycles)

OR 1.95
(1.10 to 3.44)

342
(1 study)

⊕⊕⊕⊝
moderate^a

‐

Multiple pregnancy rate per couple

OR 1.05
(0.07 to 16.90)

342
(1 study)

⊕⊕⊝⊝
low^b

‐

Pregnancy rate per couple (all cycles)

OR 1.77
(1.01 to 3.08)

342
(1 study)

⊕⊕⊕⊝
moderate^a

‐

Ovarian hyperstimulation syndrome rate per woman ‐ not reported

‐

‐

See comment

No data reported on outcome

Miscarriage rater per couple

OR 0.91
(0.32 to 2.58)

342
(1 study)

⊕⊕⊝⊝
low^b

‐

Ectopic pregnancy rate per couple

OR 5.30
(0.25 to 111.26)

342
(1 study)

⊕⊕⊝⊝
low^b

‐

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; OR: Odds ratio;

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

IUI in stimulated cycle compared to IUI in natural cycle for unexplained subfertility

Patient or population: participants with unexplained subfertility
Settings: fertility clinic
Intervention: IUI in a stimulated cycle
Comparison: IUI in a natural cycle

Live birth rare per couple (all cycles)

OR 2.07
(1.22 to 3.50)

396
(4 studies)

⊕⊕⊝⊝
low^a,b

‐

Multiple pregnancy rate per couple

OR 3.00
(0.11 to 78.27)

39
(1 study)

⊕⊕⊝⊝
low^c

‐

Pregnancy rate per couple (all cycles)

OR 6.43
(0.56 to 73.35)

26
(1 study)

⊕⊕⊝⊝
low^c

‐

Ovarian hyperstimulation syndrome rate per woman ‐ not measured

Not estimable

‐

See comment

No events in intervention and control groups

Miscarriage rate per couple

OR 5.21
(0.19 to 141.08)

26
(1 study)

⊕⊕⊝⊝
low^c

‐

Ectopic pregnancy rate per couple

OR 6.48
(0.33 to 127.09)

211
(1 study)

⊕⊝⊝⊝
very low^b,c

‐

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; OR: Odds ratio;

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.