Scolaris Content Display Scolaris Content Display

Comparison 1 IUI versus TI both in natural cycles, Outcome 1 Pregnancy rate per couple (all cycles).
Figuras y tablas -
Analysis 1.1

Comparison 1 IUI versus TI both in natural cycles, Outcome 1 Pregnancy rate per couple (all cycles).

Comparison 2 IUI versus TI both in stimulated cycles, Outcome 1 Live birth rate per couple (all cycles).
Figuras y tablas -
Analysis 2.1

Comparison 2 IUI versus TI both in stimulated cycles, Outcome 1 Live birth rate per couple (all cycles).

Comparison 2 IUI versus TI both in stimulated cycles, Outcome 2 Pregnancy rate per couple (all cycles).
Figuras y tablas -
Analysis 2.2

Comparison 2 IUI versus TI both in stimulated cycles, Outcome 2 Pregnancy rate per couple (all cycles).

Comparison 2 IUI versus TI both in stimulated cycles, Outcome 3 Multiple pregnancy rate per couple.
Figuras y tablas -
Analysis 2.3

Comparison 2 IUI versus TI both in stimulated cycles, Outcome 3 Multiple pregnancy rate per couple.

Comparison 2 IUI versus TI both in stimulated cycles, Outcome 4 Miscarriage rate per couple.
Figuras y tablas -
Analysis 2.4

Comparison 2 IUI versus TI both in stimulated cycles, Outcome 4 Miscarriage rate per couple.

Comparison 5 IUI in stimulated cycles versus IUI in natural cycles, Outcome 1 Live birth rate per couple (all cycles).
Figuras y tablas -
Analysis 5.1

Comparison 5 IUI in stimulated cycles versus IUI in natural cycles, Outcome 1 Live birth rate per couple (all cycles).

Comparison 5 IUI in stimulated cycles versus IUI in natural cycles, Outcome 2 Ongoing pregnancy rate per couple (all cycles).
Figuras y tablas -
Analysis 5.2

Comparison 5 IUI in stimulated cycles versus IUI in natural cycles, Outcome 2 Ongoing pregnancy rate per couple (all cycles).

Comparison 5 IUI in stimulated cycles versus IUI in natural cycles, Outcome 3 Pregnancy rate per couple (all cycles).
Figuras y tablas -
Analysis 5.3

Comparison 5 IUI in stimulated cycles versus IUI in natural cycles, Outcome 3 Pregnancy rate per couple (all cycles).

Comparison 5 IUI in stimulated cycles versus IUI in natural cycles, Outcome 4 Live Birth or pregnancy all cycles.
Figuras y tablas -
Analysis 5.4

Comparison 5 IUI in stimulated cycles versus IUI in natural cycles, Outcome 4 Live Birth or pregnancy all cycles.

Comparison 5 IUI in stimulated cycles versus IUI in natural cycles, Outcome 5 Miscarriages per couple.
Figuras y tablas -
Analysis 5.5

Comparison 5 IUI in stimulated cycles versus IUI in natural cycles, Outcome 5 Miscarriages per couple.

Table 1. Risk of bias of Included Studies

Comparison

Study ID

Randomisation Method

Concealed Allocation

Design

Total pts randomised

Drop outs

Cancelled Cycles

Intention to Treat

Power calculation

IUI in NC vs TI in NC

Ho 1989

Random numbers table

A (sequential numbered opaque envelopes)

Cross‐over alternating

47

Unclear

Unclear

Not possible

No

Kerin 1984

Unclear

Unclear

Cross‐over alternating

21

Unclear

Unclear

Yes possible

No

Kerin 1987

Unclear

Unclear

Cross‐over alternating

Unclear

Unclear

Unclear

Not possible

No

Kirby 1991

Unclear

Unclear

Cross‐over alternating

188

Unclear

Unclear

Not possible

No

te Velde 1989

Random numbers table

A (sealed opaque envelopes)

Cross‐over alternating

30

Unclear

Unclear

Not possible

No

IUI in NC vs TI + OH

IUI in NC vs IUI + OH

Arici1994

On site computer system with locks

A (on site locked compu system)

Cross‐over alternating

30 (75)

Before start first cycle 19 (25%), during treatment another 22 dropped out (50%)

Not stated for male subfertility only

Not possible

No

Cohlen 1998

Random numbers table

A (sealed opaque envelopes)

Cross‐over alternating

74

9 (12%)

12 (320 started)

Yes, possible

Yes

Goverde 2000

Computer generated randomisation scheduled

A (administered by numbered and masked sealed envelopes)

Parallel

51

6 (12%)

Unclear

Not clear

Yes

Guzick 1999

Computer generated permuted block

A (locked computer files)

Parallel

487 with male subfertility 932 total

72 of whole group(15.5%) (Not stated for male subfertility only, but for the whole group 167 (18%))

130, (5.6%) for whole group Not stated for male subfertility only

Not possible

No

IUI + OH vs TI in NC

Aribarg 1995

Unclear

Unclear

Cross‐over alternating

50

Not stated

Unclear

Not possible

No

Ho 1992

Random numbers table

A (sealed opaque envelopes)

Cross‐over alternating

15

Not stated

4

Not possible

No

IUI + OH vs TI + OH

Crosignani 1994

Drawing white or black discs from a blinded bag

A (drawing white or black discs from a blinded bag)

Cross‐over alternating

Not stated

Not stated

Not stated

Not possible

No

Gregoriou 1996

Unclear

Unclear

Cross‐over after 3 cycles

62

7 (not stated why)

29 total (14 IUI, 15TI)

Yes, possible

No

Jaroudi 1998

Sealed envelope method

Unclear

Cross‐over alternating

36

Not stated

Unclear

Not possible

No

Melis 1995

Computer‐generated

A (sequentially numbered opaque sealed envelopes)

Parallel

92 male subfertility whole group,

11 (12%) for male subfertility, 16 ( 8% ) for whole group

Unclear

Not possible

No

Nan 1994

Random numbers table

A (sealed numbered opaque sealed envelopes )

Cross‐over alternating

76

Not stated, but only (59) first cycles were started.

47, >10%

Not possible

No

Martinez 1991

Unclear

Unclear

Cross‐over alternating

16 male subfertility, 32 unexplained subfertility

5 (out of 48 for the whole group, not stated separately for male subfertility

9 cancelled cycles > 10%

Yes possible

No

Figuras y tablas -
Table 1. Risk of bias of Included Studies
Table 2. Prognostic Factors Table

Comparison

Study ID

Age Distirbution

Subfertility Years

Prime/second subfert

Nr semen samples

Sperm parameters

Previous treatment

Stimulation method

Nr Inseminations

IUI in NC vs TI in NC

Ho 1989

Mean 31.6 ys (SD 3.7)

Mean 5.3 ys (SD 2.9)

Not stated

3

pre‐wash: sperm count: 20.09 million/ml (SD ± 20.64) , or motility 44.68 % (SD 13.75), TMSC 34.31 (SD 45.72) post wash: sperm count: 3.16 million/ml (SD 5.23) , or motility 80.66 % (SD 13.22), TMSC 1.51 (SD 2.98)

14 women received CC and subsequently all ovulated. Most of the men were previously investigated and treated (no further specification.

Stimulation not used

For the first 79 cycles 1 insemination, for the following 35 cycles 2 inseminations

Kerin 1984

Not stated

> 3 yrs

Not stated

Not stated

Original ejaculate: Median Sperm conc 24 million/ml (Range 4‐340), Motility 26% (Range 12‐40), TMSC 17 million (1.8‐547) Inseminated preparation Sperm concentration 3.5 million/ml (range 0.8‐25), Motility 66% (55‐80), TMSC 0.78 (range 0.16‐6.1)

Not stated

Stimulation not used

One insemination

Kerin 1987

< 41 yrs

> 3 yrs

Not stated

3

Pre‐wash: Semen conceptual cycles: 25 million/ml (mean), 30% motility, 41 % morphology, TMSC 22 million Nonconceptual cycles; 25 million /ml, 38% motility, 42 normal morphology, TMSC 28 million Washed semen conceptional cycles: 2.8 million/ml, 70% motility, 68% normal morphology, TMSC .62 million Non conceptional; 3.0 million per ml, 73% motility, 70% morphology, TMSC .72 million

Not stated

Stimulation not used

One insemination

Kirby 1991

Not stated

>/= 2 yrs

Not stated

3

Not stated, but couples were only accepted if >100.000 motile sperm were recovered in a trial sperm washing

Not stated

Stimulation not used

One insemination

te Velde

Not stated

Mean 5.2 yrs (range 3‐12) for the whole group

Mixed in 88% there was primary infertility

3

Concentration 11.8 million (range 3‐19, motility 22% (20‐40) morphology 36% (range 24‐48)

Not stated

Stimulation not used

One insemination

UI in NC vs TI + OH

IUI vs IUI + OH

Arici 1994

Mean 33 yrs (24‐41) (For whole group)

Mean 3.5 yrs (range 1‐15)

Not stated

>/=2

Not stated

Endocrinological or surgically correctable factors were treated, but ART not stated

CC 50 mg

IUI + NC : Double IUI + OH :Single

Cohlen 1998

Median 30.7 ys (24‐39yrs)

Mean 3.1 ys (range 2‐9 ys)

Mixed 82 % primary

2

Not stated for whole group

Not stated

hMG 75 IU ‐150 IU

One insemination

Goverde 2000

IUI + NC:31.6 (+/‐ 3.7) IUI+OH (31.7 (+/‐3.9)

IUI + NC : 3.9 (+/‐ 1.7 yrs) IUI + OH:4.2 ( +/‐1.9)

Mixed 86.5% primary

5

Not stated

Not stated

hMG 75 IU starting dose

One insemination

Guzick 1998

IUI + NC: 32 yrs +/‐ 4 IUI + OH :32 yrs +/‐ 4

IUI + NC 3.8 yrs (+/‐ 2.6) IUI + OH: 3.5 yrs (+/‐ 2.2)

Mixed 60 % primary subfertility

Not stated

For whole group: Median sperm count :IUI + NC: 41 million per ml, IUI + OH 48 million/ml , Median sperm motility (%) IUI + NC: 51, IUI+ OH 49

No

FSH 150 IU

IUI+OH vs TI in NC

Aribarg 1995

Median 25.5 yrs, range 23‐37)

Mean 3.7yrs (2‐15 ys)

Not stated

2

pre wash: Sperm concentration (million/ml) 10.5 +/‐5.4, Motility (%) 40.0

Not stated

CC 100 mg

One insemination, sometimes two if ovulation had not occured after US detection)

Ho 1992

Mean 32.3 yrs (SD ± 3.4 )

Mean 4.4 yrs (SD ± 2.9)

Mixed 86.7% primary

3

pre‐ processing count 48.9 million/ ml ± 40.0, Motility (%) 49.6 ± 15.9, After processing Count (million/ml) 13.4 ± 14.3, motility (%) 74.9 ± 18.3

Not stated

FSH 75 IU + LH 75 IU

One insemination, sometimes two if ovulation had not occured after US detection)

IUI+OH vs TI + OH

Crosignani 1994

Not stated

Not stated

Not stated

Not stated

Not stated

Not stated

Not stated

Not stated

Gregoriou 1996

Mean 30.5 yrs (SD ± 2.6)

Mean 5.8 yrs ( ± 3.9)

Mixed 84% with primary infertility

3

Not stated

Not stated

hMG 75 IU‐150 IU

One insemination

Jaroudi 1998

mean 27 ys (SD ± 3.7)

6.5 yrs (SD ± 3)

Mixed 72% with primary infertility

3

Abnormal morphology 58 (SD ± 26). Average sperm count 41 million (SD ± 33), average motility was 25% (SD ± 25),

Not stated

hMG 150 IU

One insemination

Melis 1995

Mean 34.2 yrs (SD ± 4.8 )

Mean 4.3 yrs ( ± 1.2 yrs)

Not stated

2

Sperm count 15.0 million /ml, progressive motility 21.5%, Total motility 45.1%

All couples had undergone 3 cycles of CC associated with TI and three cycles of CC and IUI without conceiving before enrolment in this trial

FSH 225 IU

One insemination

Nan 1994

Mean 32 yrs (range 24‐39)

Mean 4.5 yrs (range 2‐10)

Mixed, 80% primary

4

Not stated

Not stated

hMG 150 IU

One insemination

Martinez

Mean 33 yrs ( ± 2.9 yrs)

Mean 6.3 ys (SD ± 2.8 ys, range 3‐14 ys

Not stated.

2 or more

Not stated

For the whole group; 27 were previously treated with IUI in either spontaneous or CC stimulated cycles and had failed to conceive. Three had received ICSI, 3,6 or 12 times, One couple had 2 cycles of GIFT

hMG 75 IU

One insemination

Figuras y tablas -
Table 2. Prognostic Factors Table
Comparison 1. IUI versus TI both in natural cycles

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Pregnancy rate per couple (all cycles) Show forest plot

1

21

Peto Odds Ratio (Peto, Fixed, 95% CI)

5.29 [0.42, 66.48]

Figuras y tablas -
Comparison 1. IUI versus TI both in natural cycles
Comparison 2. IUI versus TI both in stimulated cycles

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Live birth rate per couple (all cycles) Show forest plot

1

81

Peto Odds Ratio (Peto, Fixed, 95% CI)

0.89 [0.31, 2.58]

1.1 gonadotrophins

1

81

Peto Odds Ratio (Peto, Fixed, 95% CI)

0.89 [0.31, 2.58]

2 Pregnancy rate per couple (all cycles) Show forest plot

3

202

Odds Ratio (M‐H, Fixed, 95% CI)

1.67 [0.83, 3.37]

2.1 gonadotrophins

3

202

Odds Ratio (M‐H, Fixed, 95% CI)

1.67 [0.83, 3.37]

3 Multiple pregnancy rate per couple Show forest plot

1

81

Odds Ratio (M‐H, Fixed, 95% CI)

3.15 [0.12, 79.69]

3.1 gonadotrophins

1

81

Odds Ratio (M‐H, Fixed, 95% CI)

3.15 [0.12, 79.69]

4 Miscarriage rate per couple Show forest plot

1

81

Odds Ratio (M‐H, Fixed, 95% CI)

1.03 [0.19, 5.42]

4.1 gonadotrophins

1

81

Odds Ratio (M‐H, Fixed, 95% CI)

1.03 [0.19, 5.42]

Figuras y tablas -
Comparison 2. IUI versus TI both in stimulated cycles
Comparison 5. IUI in stimulated cycles versus IUI in natural cycles

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Live birth rate per couple (all cycles) Show forest plot

2

53

Odds Ratio (M‐H, Fixed, 95% CI)

0.87 [0.28, 2.70]

1.1 Gonadotrophins

2

53

Odds Ratio (M‐H, Fixed, 95% CI)

0.87 [0.28, 2.70]

2 Ongoing pregnancy rate per couple (all cycles) Show forest plot

3

379

Odds Ratio (M‐H, Fixed, 95% CI)

1.43 [0.88, 2.31]

2.1 gonadotrophins

3

379

Odds Ratio (M‐H, Fixed, 95% CI)

1.43 [0.88, 2.31]

3 Pregnancy rate per couple (all cycles) Show forest plot

4

409

Odds Ratio (M‐H, Random, 95% CI)

1.47 [0.91, 2.38]

3.1 gonadotrophins

3

379

Odds Ratio (M‐H, Random, 95% CI)

1.43 [0.88, 2.33]

3.2 CC

1

30

Odds Ratio (M‐H, Random, 95% CI)

4.83 [0.18, 128.79]

4 Live Birth or pregnancy all cycles Show forest plot

4

409

Odds Ratio (M‐H, Fixed, 95% CI)

1.28 [0.77, 2.15]

4.1 Live Birth

2

305

Odds Ratio (M‐H, Fixed, 95% CI)

1.31 [0.75, 2.29]

4.2 Pregnancy

2

104

Odds Ratio (M‐H, Fixed, 95% CI)

1.14 [0.30, 4.42]

5 Miscarriages per couple Show forest plot

1

74

Odds Ratio (M‐H, Fixed, 95% CI)

1.06 [0.20, 5.63]

5.1 gonadotrophins

1

74

Odds Ratio (M‐H, Fixed, 95% CI)

1.06 [0.20, 5.63]

Figuras y tablas -
Comparison 5. IUI in stimulated cycles versus IUI in natural cycles