Scolaris Content Display Scolaris Content Display

L'insémination intra‐utérine versus l’injection de spermatozoïdes dans les trompes de Fallope pour l'infertilité non‐tubaire

Appendices

Appendix 1. MEDLINE

1 Insemination, Artificial/ (6821)
2 (intrauter$ adj5 inseminat$).tw. (1194)
3 (intra‐uter$ adj5 inseminat$).tw. (131)
4 IUI.tw. (703)
5 or/1‐4 (7614)
6 fallopian tube sperm perfusion.tw. (19)
7 FSP.tw. (446)
8 (Fallopian adj5 sperm$).tw. (97)
9 (tub$ adj5 sperm$).tw. (1868)
10 sperm$ flush$.tw. (7)
11 or/6‐10 (2326)
12 5 and 11 (80)
13 randomised controlled trial.pt. (234274)
14 controlled clinical trial.pt. (74820)
15 Randomized Controlled Trials/ (48327)
16 Random allocation/ (57750)
17 Double‐blind method/ (91028)
18 Single‐blind method/ (10880)
19 or/13‐18 (397294)
20 clinical trial.pt. (435392)
21 exp clinical trials/ (190560)
22 (clin$ adj25 trial$).ti,ab,sh. (129372)
23 ((singl$ or doubl$ or tripl$ or trebl$) adj25 (blind$ or mask$)).ti,ab,sh. (90362)
24 Placebos/ (26128)
25 placebo$.ti,ab,sh. (114490)
26 random$.ti,ab,sh. (490003)
27 Research design/ (47276)
28 or/20‐27 (866440)
29 animal/ not (human/ and animal/) (3095759)
30 19 or 28 (873731)
31 30 not 29 (800552)
32 12 and 31 (23)
33 (2003$ or 2004$ or 2005$ or 2006$ or 2007$).ed. (3111083)
34 32 and 33 (5)
35 from 34 keep 1‐5 (5)

Appendix 2. CENTRAL

1 Insemination, Artificial/ (112)
2 (intrauter$ adj5 inseminat$).tw. (290)
3 (intra‐uter$ adj5 inseminat$).tw. (22)
4 IUI.tw. (206)
5 or/1‐4 (378)
6 fallopian tube sperm perfusion.tw. (21)
7 FSP.tw. (30)
8 (Fallopian adj5 sperm$).tw. (29)
9 (tub$ adj5 sperm$).tw. (47)
10 sperm$ flush$.tw. (0)
11 or/6‐10 (70)
12 5 and 11 (30)
13 from 12 keep 1‐30 (30)

Appendix 3. CINAHL

1 Insemination, Artificial/ (163)
2 (intrauter$ adj5 inseminat$).tw. (30)
3 (intra‐uter$ adj5 inseminat$).tw. (4)
4 IUI.tw. (16)
5 or/1‐4 (178)
6 fallopian tube sperm perfusion.tw. (2)
7 FSP.tw. (17)
8 (Fallopian adj5 sperm$).tw. (2)
9 (tub$ adj5 sperm$).tw. (7)
10 sperm$ flush$.tw. (0)
11 or/6‐10 (22)
12 5 and 11 (2)
13 exp clinical trials/ (43714)
14 Clinical trial.pt. (20712)
15 (clinic$ adj trial$1).tw. (10227)
16 ((singl$ or doubl$ or trebl$ or tripl$) adj (blind$3 or mask$3)).tw. (6114)
17 Randomi?ed control$ trial$.tw. (8946)
18 Random assignment/ (15159)
19 Random$ allocat$.tw. (1023)
20 Placebo$.tw. (8559)
21 Placebos/ (3489)
22 Quantitative studies/ (3196)
23 Allocat$ random$.tw. (60)
24 or/13‐23 (61301)
25 12 and 24 (2)
26 from 25 keep 1‐2 (2)

Appendix 4. EMBASE

1 fallopian tube sperm perfusion.tw. (22)
2 FSP.tw. (345)
3 (Fallopian adj5 sperm$).tw. (80)
4 (tub$ adj5 sperm$).tw. (1383)
5 sperm$ flush$.tw. (5)
6 or/1‐5 (1737)
7 exp Artificial Insemination/ (3671)
8 (intrauter$ adj5 inseminat$).tw. (1172)
9 (intra‐uter$ adj5 inseminat$).tw. (129)
10 IUI.tw. (737)
11 or/7‐10 (4753)
12 6 and 11 (74)
13 Controlled study/ or randomised controlled trial/ (2405316)
14 double blind procedure/ (63789)
15 single blind procedure/ (6559)
16 crossover procedure/ (18585)
17 drug comparison/ (81250)
18 placebo/ (97915)
19 random$.ti,ab,hw,tn,mf. (367123)
20 latin square.ti,ab,hw,tn,mf. (1064)
21 crossover.ti,ab,hw,tn,mf. (32554)
22 cross‐over.ti,ab,hw,tn,mf. (11275)
23 placebo$.ti,ab,hw,tn,mf. (146355)
24 ((doubl$ or singl$ or tripl$ or trebl$) adj5 (blind$ or mask$)).ti,ab,hw,tn,mf. (106285)
25 (comparative adj5 trial$).ti,ab,hw,tn,mf. (5769)
26 (clinical adj5 trial$).ti,ab,hw,tn,mf. (483066)
27 or/13‐26 (2886258)
28 nonhuman/ (2878264)
29 animal/ not (human/ and animal/) (12847)
30 or/28‐29 (2881866)
31 27 not 30 (1695407)
32 12 and 31 (28)
33 (2003$ or 2004$ or 2005$ or 2006$ or 2007$).em. (2449289)
34 32 and 33 (6)
35 from 34 keep 1‐6 (6)

Appendix 5. Data collected

Types of participant

  • What was the duration of subfertility?

  • Were prognostic factors such as the age of the woman and the duration of subfertility considered?

  • Were female factors excluded or corrected? All women had to have regular menstrual cycles with biphasic body temperature charts or normal luteal progesterone; patent tubes on hysterosalpingography (HSG) or laparoscopy; no cervical factors, thus a positive post‐coital test or normal cervical mucus with pH > 6.3 and Insler score > 11.

  • Had treatments been applied previously? Was it tubal surgery, controlled ovarian hyperstimulation without insemination, or other?

Types of intervention

  • What method of controlled ovarian hyperstimulation (COH) was used?

  • Were criteria to cancel the insemination because of the risk of multiple pregnancies or ovarian hyperstimulation syndrome (cancellation criteria) described?

  • Duration of treatment: How many treatment cycles were offered?

  • How many inseminations were performed per cycle?

  • What timing method was used in natural cycles: with luteinising hormone (LH) in blood or urine?

  • What timing method was used in cycles with COH. When no GnRHa was used: Was LH also measured in cycles with COH?

  • What was the actual timing of IUI or FSP? Was IUI or FSP in natural cycles performed 20 to 40 hours after the onset of the LH surge was detected, and in cycles with COH 35 to 45 hours after hCG?

  • Which semen was inseminated (donor semen or partner semen)?

  • What method of semen preparation was applied?

  • What were the semen characteristics before and after sperm processing (especially the number of motile spermatozoa that were inseminated)?

Types of outcome measure

·                 Primary outcome

  • Number of live births

·                 Secondary outcomes

  • Number of clinical pregnancies

  • Number of multiple pregnancies

  • Spontaneous abortion rate

  • Number of tubal pregnancies

Study flow diagram.
Figuras y tablas -
Figure 1

Study flow diagram.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Methodological quality graph: review authors' judgements about all methodological quality items presented as percentages across all included studies.
Figuras y tablas -
Figure 2

Methodological quality graph: review authors' judgements about all methodological quality items presented as percentages across all included studies.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Methodological quality summary: review authors' judgements about all methodological quality items for each included study.
Figuras y tablas -
Figure 3

Methodological quality summary: review authors' judgements about all methodological quality items for each included study.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Forest plot of comparison: 1 NEW Intrauterine insemination versus fallopian tube sperm perfusion, outcome: 1.1 Live birth per couple.
Figuras y tablas -
Figure 4

Forest plot of comparison: 1 NEW Intrauterine insemination versus fallopian tube sperm perfusion, outcome: 1.1 Live birth per couple.

Ir a la figura de la revisiónAbrir en una pestaña nueva

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).
Figuras y tablas -
Figure 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).

Ir a la figura de la revisiónAbrir en una pestaña nueva

Funnel plot of comparison: 1 IUI versus FSP, outcome: 1.2 Clinical pregnancy per couple.
Figuras y tablas -
Figure 6

Funnel plot of comparison: 1 IUI versus FSP, outcome: 1.2 Clinical pregnancy per couple.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 1 IUI versus FSP, Outcome 1 Live birth per couple.
Figuras y tablas -
Analysis 1.1

Comparison 1 IUI versus FSP, Outcome 1 Live birth per couple.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 1 IUI versus FSP, Outcome 2 Clinical pregnancy per couple.
Figuras y tablas -
Analysis 1.2

Comparison 1 IUI versus FSP, Outcome 2 Clinical pregnancy per couple.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 1 IUI versus FSP, Outcome 3 Multiple pregnancy.
Figuras y tablas -
Analysis 1.3

Comparison 1 IUI versus FSP, Outcome 3 Multiple pregnancy.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 1 IUI versus FSP, Outcome 4 Miscarriage rate.
Figuras y tablas -
Analysis 1.4

Comparison 1 IUI versus FSP, Outcome 4 Miscarriage rate.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 1 IUI versus FSP, Outcome 5 Ectopic pregnancy.
Figuras y tablas -
Analysis 1.5

Comparison 1 IUI versus FSP, Outcome 5 Ectopic pregnancy.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 2 IUI versus FSP subgroups by indication, Outcome 1 Unexplained subfertility.
Figuras y tablas -
Analysis 2.1

Comparison 2 IUI versus FSP subgroups by indication, Outcome 1 Unexplained subfertility.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 2 IUI versus FSP subgroups by indication, Outcome 2 Mild to moderate male factor subfertility.
Figuras y tablas -
Analysis 2.2

Comparison 2 IUI versus FSP subgroups by indication, Outcome 2 Mild to moderate male factor subfertility.

Ir a la figura de la revisiónAbrir en una pestaña nueva
Summary of findings for the main comparison. IUI compared with FSP for non‐tubal infertility

IUI compared with FSP for non‐tubal infertility

Patient or population: women with non‐tubal infertility
Settings: subfertility clinic
Intervention: intrauterine insemination
Comparison: fallopian tube sperm perfusion

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

FSP

IUI

Live birth per couple

133 per 1000

126 per 1000
(83 to 186)

OR 0.94
(0.59 to 1.49)

633
(3 studies)

⊕⊕⊝⊝
low1,2

Clinical pregnancy per couple

185 per 1000

145 per 1000
(100 to 202)

OR 0.75
(0.49 to 1.12)

1745
(14 studies)

⊕⊕⊝⊝
low3,4

Multiple pregnancy per couple

70 per 1000

55 per 1000
(33 to 91)

OR 0.62
(0.29 to 1.32)

908
(7 studies)

⊕⊕⊝⊝
low2,3

Miscarriage per couple

43 per 1000

46 per 1000
(24 to 84)

OR 1.07
(0.56 to 2.05)

884
(7 studies)

⊕⊕⊝⊝
low2,3

Ectopic pregnancy per couple

10 per 1000

8 per 1000
(2 to 30)

OR 0.88
(0.24 to 3.19)

643
(4 studies)

⊕⊝⊝⊝
very low2,3,5

*The basis for the assumed risk (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.

1One of the three studies did not describe method of allocation concealment and 19% of women in this study had mild tubal damage.
2Imprecision: Confidence intervals cross the line of no effect and do not exclude an appreciable benefit or harm.
3Most studies failed to provide adequate details of methods of sequence generation and allocation concealment.
4Unexplained statistical heterogeneity (I2 = 52%).
5Very serious imprecision.

Figuras y tablas -
Summary of findings for the main comparison. IUI compared with FSP for non‐tubal infertility
Ir a la tabla de la revisión
Table 1. Per cycle data

Study

Clinical pregnancy per cycle

IUI

FSP

P value

Fanchin 1995

10/50 (20%)

20/50 (40%)

P < 0.04

Filer 1996

12/59 (20%)

5/47 (11%)

P > 0.05
Figuras y tablas -
Table 1. Per cycle data
Ir a la tabla de la revisión
Comparison 1. IUI versus FSP

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Live birth per couple Show forest plot

3

633

Odds Ratio (M‐H, Fixed, 95% CI)

0.94 [0.59, 1.49]

2 Clinical pregnancy per couple Show forest plot

14

Odds Ratio (M‐H, Random, 95% CI)

Subtotals only

3 Multiple pregnancy Show forest plot

8

Odds Ratio (M‐H, Fixed, 95% CI)

Subtotals only

3.1 Multiple pregnancy per couple

7

908

Odds Ratio (M‐H, Fixed, 95% CI)

0.62 [0.29, 1.32]

3.2 Sensitivity analysis: multiple pregnancy per pregnancy

8

197

Odds Ratio (M‐H, Fixed, 95% CI)

0.96 [0.44, 2.07]

4 Miscarriage rate Show forest plot

7

Odds Ratio (M‐H, Fixed, 95% CI)

Subtotals only

4.1 Miscarriage per couple

7

884

Odds Ratio (M‐H, Fixed, 95% CI)

1.07 [0.56, 2.05]

4.2 Miscarriage per pregnancy

7

180

Odds Ratio (M‐H, Fixed, 95% CI)

1.32 [0.63, 2.78]

5 Ectopic pregnancy Show forest plot

4

Odds Ratio (M‐H, Fixed, 95% CI)

Subtotals only

5.1 Ectopic pregnancy per couple

4

643

Odds Ratio (M‐H, Fixed, 95% CI)

0.88 [0.24, 3.19]

5.2 Ectopic pregnancy per pregnancy

4

111

Odds Ratio (M‐H, Fixed, 95% CI)

1.71 [0.42, 6.88]
Figuras y tablas -
Comparison 1. IUI versus FSP
Ir a la tabla de la revisión
Comparison 2. IUI versus FSP subgroups by indication

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Unexplained subfertility Show forest plot

7

378

Odds Ratio (M‐H, Fixed, 95% CI)

0.63 [0.39, 1.02]

1.1 Clinical pregnancy

7

378

Odds Ratio (M‐H, Fixed, 95% CI)

0.63 [0.39, 1.02]

2 Mild to moderate male factor subfertility Show forest plot

5

Odds Ratio (M‐H, Fixed, 95% CI)

Subtotals only

2.1 Live birth

1

120

Odds Ratio (M‐H, Fixed, 95% CI)

0.40 [0.14, 1.14]

2.2 Clinical pregnancy

5

303

Odds Ratio (M‐H, Fixed, 95% CI)

0.53 [0.28, 1.01]
Figuras y tablas -
Comparison 2. IUI versus FSP subgroups by indication
Ir a la tabla de la revisión