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Cochrane Database of Systematic Reviews

Inseminación intrauterina versus perfusión de esperma en la trompa de Falopio para la esterilidad no tubaria

Información

DOI:
https://doi.org/10.1002/14651858.CD001502.pub4Copiar DOI
Base de datos:
  1. Cochrane Database of Systematic Reviews
Versión publicada:
  1. 30 octubre 2013see what's new
Tipo:
  1. Intervention
Etapa:
  1. Review
Grupo Editorial Cochrane:

  1. Grupo Cochrane de Ginecología y fertilidad

Copyright:
  1. Copyright © 2013 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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Contraer

Autores

  • Astrid EP Cantineau

    Correspondencia a: Department of Obstetrics & Gynaecology, University Medical Centre, Groningen, Netherlands

    [email protected]

  • Ben J Cohlen

    Department of Obstetrics & Gynaecology, Isala Clinics, Location Sophia, Zwolle, Netherlands

  • Maas Jan Heineman

    Department of Obstetrics & Gynaecology Academic Medical Centre, University of Amsterdam, Amsterdam, Netherlands

  • Jane Marjoribanks

    Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand

  • Cindy Farquhar

    Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand

Contributions of authors

AEP Cantineau did the literature search and selected relevant trials for inclusion in the review. She also performed the statistical analyses and wrote the bulk of the results and discussion section. She analysed articles for the update of the review, updated the review in 2008 and advised on the structure, text and interpretation of the 2013 draft of the review.

MJ Heineman was the second review author for selection of relevant trials for inclusion. For the update, he analysed the selected articles. He also contributed to drafts of the review.

BJ Cohlen together with JH Evers and H Al‐Inany took the lead in writing the original protocol for this review, was the third review author and resolved any disagreements between the first two review authors. He also contributed to drafts of the review and contributed to the update of the review.

C Farquhar selected the studies, extracted the data and advised on the structure, text and interpretation of the 2013 draft of the review.

J Marjoribanks selected the studies, extracted the data and drafted the 2013 update of the review.

Sources of support

Internal sources

  • Isala Clinics, Zwolle, Netherlands.

    Visit congress meetings to present results of review

  • The Cochrane Collaboration, New Zealand.

    Technical support

  • University Medical Centre, Groningen, Netherlands.

    Technical support

External sources

  • No sources of support supplied

Declarations of interest

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

Acknowledgements

The authors wish to thank Marian Showell (Menstrual Disorders and Subfertility Group Trials Search Co‐ordinator) for help with the literature search and the following authors for providing additional data about their studies: Dr Jain, Dr Biacchiardi, Dr Gregoriou, Dr Papier, Dr Ciftci and Dr El‐Khayat.

Version history

Published

Title

Stage

Authors

Version

2013 Oct 30

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

Review

Astrid EP Cantineau, Ben J Cohlen, Maas Jan Heineman, Jane Marjoribanks, Cindy Farquhar

https://doi.org/10.1002/14651858.CD001502.pub4

2009 Apr 15

Intra‐uterine insemination versus fallopian tube sperm perfusion for non‐tubal infertility

Review

Astrid EP Cantineau, Ben J Cohlen, Maas Jan Heineman

https://doi.org/10.1002/14651858.CD001502.pub3

2004 Jul 19

Intrauterine insemination versus fallopian tube sperm perfusion for non tubal infertility

Review

Astrid EP Cantineau, Ben J Cohlen, Maas Jan Heineman

https://doi.org/10.1002/14651858.CD001502.pub2

2003 Jul 21

Intra‐uterine insemination versus fallopian tube sperm perfusion for non tubal infertility

Protocol

Astrid EP Cantineau, Maas Jan Heineman, Ben J Cohlen, Hesham Al‐Inany, Johannes LH Evers

https://doi.org/10.1002/14651858.CD001502

Differences between protocol and review

2013 update.

  • Methods were updated in accordance with current Cochrane methodological standards.

  • Participant inclusion criteria were widened to "non‐tubal infertility".

  • OHSS was deleted as an outcome.

  • Sensitivity analysis was conducted for clinical pregnancy rather than live birth because only three studies reported live birth.

  • Both per‐couple (main analysis) and per‐pregnancy (sensitivity analysis) analyses were conducted for multiple pregnancy, miscarriage and ectopic pregnancy.

  • A random‐effects model was used if substantial heterogeneity was detected (I2 > 50%).

Keywords

MeSH

Medical Subject Headings (MeSH) Keywords

Medical Subject Headings Check Words

Female; Humans; Pregnancy;

PICO

Population
Intervention
Comparison
Outcome

El uso y la enseñanza del modelo PICO están muy extendidos en el ámbito de la atención sanitaria basada en la evidencia para formular preguntas y estrategias de búsqueda y para caracterizar estudios o metanálisis clínicos. PICO son las siglas en inglés de cuatro posibles componentes de una pregunta de investigación: paciente, población o problema; intervención; comparación; desenlace (outcome).

Para saber más sobre el uso del modelo PICO, puede consultar el Manual Cochrane.

Study flow diagram.
Figuras y tablas -
Figure 1

Study flow diagram.

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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.

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

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

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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.

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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).
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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).

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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.

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Comparison 1 IUI versus FSP, Outcome 1 Live birth per couple.
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Analysis 1.1

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

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Comparison 1 IUI versus FSP, Outcome 2 Clinical pregnancy per couple.
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Analysis 1.2

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

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Comparison 1 IUI versus FSP, Outcome 3 Multiple pregnancy.
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Analysis 1.3

Comparison 1 IUI versus FSP, Outcome 3 Multiple pregnancy.

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Comparison 1 IUI versus FSP, Outcome 4 Miscarriage rate.
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Analysis 1.4

Comparison 1 IUI versus FSP, Outcome 4 Miscarriage rate.

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Comparison 1 IUI versus FSP, Outcome 5 Ectopic pregnancy.
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Analysis 1.5

Comparison 1 IUI versus FSP, Outcome 5 Ectopic pregnancy.

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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.

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

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

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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
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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
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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
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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
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