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

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

doi:10.1002/14651858.CD001502.pub4

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Figure 1

Study flow diagram.

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Figure 2

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

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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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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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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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Figure 6

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

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Analysis 1.1

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

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Analysis 1.2

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

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Analysis 1.3

Comparison 1 IUI versus FSP, Outcome 3 Multiple pregnancy.

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Analysis 1.4

Comparison 1 IUI versus FSP, Outcome 4 Miscarriage rate.

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Analysis 1.5

Comparison 1 IUI versus FSP, Outcome 5 Ectopic pregnancy.

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Analysis 2.1

Comparison 2 IUI versus FSP subgroups by indication, Outcome 1 Unexplained 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)	⊕⊕⊝⊝ low^1,2
Clinical pregnancy per couple	185 per 1000	145 per 1000 (100 to 202)	OR 0.75 (0.49 to 1.12)	1745 (14 studies)	⊕⊕⊝⊝ low^3,4
Multiple pregnancy per couple	70 per 1000	55 per 1000 (33 to 91)	OR 0.62 (0.29 to 1.32)	908 (7 studies)	⊕⊕⊝⊝ low^2,3
Miscarriage per couple	43 per 1000	46 per 1000 (24 to 84)	OR 1.07 (0.56 to 2.05)	884 (7 studies)	⊕⊕⊝⊝ low^2,3
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 low^2,3,5
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.

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

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]

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]

Comparison 2. IUI versus FSP subgroups by indication

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