Synchronised approach for intrauterine insemination in subfertile couples

Astrid EP Cantineau; Mirjam J Janssen; Ben J Cohlen; Thomas Allersma

doi:10.1002/14651858.CD006942.pub3

Scolaris Content Display Scolaris Content Display

Contenido relacionado

Ir a:

Revisiones y protocolos relacionados
Guías
Temas

Revisiones y protocolos relacionados

Topics

Temas

Figure 1

Study flow diagram for 2009 to 2013 literature searches.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Figure 2

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

Figure 3

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

Figure 4

Forest plot of comparison: 1 hCG versus LH surge, outcome: 1.2 pregnancy rate per couple.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Figure 5

Forest plot of comparison: 2 u‐hCG versus r‐hCG, outcome: 2.2 pregnancy rate per couple.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Figure 6

Forest plot of comparison: 2 u‐hCG versus r‐hCG, outcome: 2.4 miscarriage rate per pregnancy.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Figure 7

Forest plot of comparison: 3 short versus long interval, outcome: 3.2 pregnancy rate per couple.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Figure 8

Forest plot of comparison: 3 short versus long interval, outcome: 3.3 miscarriage rate per pregnancy.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Figure 9

Forest plot of comparison: 4 hCG versus GnRH‐a, outcome: 4.1 live birth rate per couple.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Figure 10

Forest plot of comparison: 4 hCG versus GnRH‐a, outcome: 4.2 pregnancy rate per couple.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Figure 11

Forest plot of comparison: 4 hCG versus GnRH‐a, outcome: 4.3 multiple pregnancy rate per pregnancy.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Figure 12

Forest plot of comparison: 4 hCG versus GnRH‐a, outcome: 4.4 miscarriage rate per pregnancy.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.1

Comparison 1 hCG versus LH surge, Outcome 1 live birth rate per couple.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.2

Comparison 1 hCG versus LH surge, Outcome 2 pregnancy rate per couple.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.3

Comparison 1 hCG versus LH surge, Outcome 3 multiple pregnancy rate per pregnancy.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.1

Comparison 2 u‐hCG versus r‐hCG, Outcome 1 live birth rate per couple.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.2

Comparison 2 u‐hCG versus r‐hCG, Outcome 2 pregnancy rate per couple.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.3

Comparison 2 u‐hCG versus r‐hCG, Outcome 3 multiple pregnancy rate per pregnancy.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.4

Comparison 2 u‐hCG versus r‐hCG, Outcome 4 miscarriage rate per pregnancy.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 2.5

Comparison 2 u‐hCG versus r‐hCG, Outcome 5 OHSS rate per cycle.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.1

Comparison 3 Short versus long interval, Outcome 1 live birth rate per couple.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.2

Comparison 3 Short versus long interval, Outcome 2 pregnancy rate per couple.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 3.3

Comparison 3 Short versus long interval, Outcome 3 miscarriage rate per pregnancy.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 4.1

Comparison 4 hCG versus GnRH‐a, Outcome 1 live birth rate per couple.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 4.2

Comparison 4 hCG versus GnRH‐a, Outcome 2 pregnancy rate per couple.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 4.3

Comparison 4 hCG versus GnRH‐a, Outcome 3 multiple pregnancy rate per pregnancy.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 4.4

Comparison 4 hCG versus GnRH‐a, Outcome 4 miscarriage rate per pregnancy.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 4.5

Comparison 4 hCG versus GnRH‐a, Outcome 5 OHSS per cycle.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 5.1

Comparison 5 Early hCG versus late hCG, Outcome 1 pregnancy rate per couple.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 5.2

Comparison 5 Early hCG versus late hCG, Outcome 2 miscarriage rate.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 6.1

Comparison 6 Different dosages of hCG, Outcome 1 pregnancy rate per couple.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Summary of findings for the main comparison. hCG compared to LH surge for intrauterine insemination in subfertile couples

hCG compared to LH surge for intrauterine insemination in subfertile couples
Population: women undergoing intrauterine insemination Intervention: hCG Comparison: LH surge
Outcomes	*Illustrative comparative risks (95% CI)**		Relative effect (95% CI)	No of participants (studies)	Quality of the evidence (GRADE)	Comments
	Assumed risk	Corresponding risk
	LH surge	HCG
Live birth rate per couple	83 per 1000	83 per 1000 (5 to 621)	OR 1 (0.06 to 18.08)	24 (1 study)	⊕⊝⊝⊝ very low^1,2
Pregnancy rate per couple	146 per 1000	185 per 1000 (110 to 295)	OR 1.33 (0.72 to 2.45)	275 (4 studies)	⊕⊕⊝⊝ low^1,3
Multiple pregnancy rate per pregnancy	59 per 1000	66 per 1000 (11 to 323)	OR 1.12 (0.17 to 7.6)	42 (2 studies)	⊕⊝⊝⊝ very low^1,2
The basis for the assumed risk* was the median control group risk across studies. 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.
¹Methods used for random sequence generation and/or allocation concealment were unclear. ²There was very serious imprecision, with small sample sizes and very few events. ³There was serious imprecision: findings were compatible with substantial benefit in either group, or with no effect.

Summary of findings for the main comparison. hCG compared to LH surge for intrauterine insemination in subfertile couples

Ir a la tabla de la revisión

Summary of findings 2. u‐hCG compared to r‐hCG for intrauterine insemination in subfertile couples

u‐hCG compared to r‐hCG for intrauterine insemination in subfertile couples
Population: women undergoing intrauterine insemination Intervention: u‐hCG Comparison: r‐hCG
Outcomes	*Illustrative comparative risks (95% CI)**		Relative effect (95% CI)	No of participants (studies)	Quality of the evidence (GRADE)	Comments
	Assumed risk	Corresponding risk
	R‐hCG	U‐hCG
Live birth rate per couple	221 per 1000	249 per 1000 (162 to 365)	OR 1.17 (0.68 to 2.03)	284 (1 study)	⊕⊕⊝⊝ low^1,2
Pregnancy rate per couple	261 per 1000	265 per 1000 (187 to 357)	OR 1.02 (0.65 to 1.57)	409 (2 studies)	⊕⊕⊝⊝ low^2,3
Multiple pregnancy rate per pregnancy	184 per 1000	182 per 1000 (83 to 358)	OR 0.99 (0.4 to 2.47)	109 (2 studies)	⊕⊕⊝⊝ low^2,3
Miscarriage rate per pregnancy	84 per 1000	50 per 1000 (12 to 185)	OR 0.57 (0.13 to 2.47)	109 (2 studies)	⊕⊝⊝⊝ very low^2,3,4
OHSS rate per cycle	See comment	See comment	Not estimable	468 (2 studies)	⊕⊕⊕⊝ moderate³	There were no events in either study
The basis for the assumed risk* was the median control group risk across studies. 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.
¹Methods used for random sequence generation and/or allocation concealment were unclear. ²There was serious imprecision: findings were compatible with substantial benefit in either group, or with no effect. ³One study did not report the method of allocation concealment used. ⁴There was very serious imprecision, with very few events and wide confidence intervals.

Summary of findings 2. u‐hCG compared to r‐hCG for intrauterine insemination in subfertile couples

Ir a la tabla de la revisión

Summary of findings 3. Short interval compared to long interval for intrauterine insemination in subfertile couples

Short interval compared to long interval for intrauterine insemination in subfertile couples
Population: women undergoing intrauterine insemination Intervention: short interval Comparison: long interval
Outcomes	*Illustrative comparative risks (95% CI)**		Relative effect (95% CI)	No of participants (studies)	Quality of the evidence (GRADE)	Comments
	Assumed risk	Corresponding risk
	Long interval	Short interval
Live birth rate per couple ‐ 24 hours versus 34 to 36 hours	298 per 1000	181 per 1000 (103 to 298)	OR 0.52 (0.27 to 1)	204 (1 study)	⊕⊕⊝⊝ low^1,2
Pregnancy rate per couple ‐ 24 hours versus 34 to 36 hours	397 per 1000	266 per 1000 (170 to 392)	OR 0.55 (0.31 to 0.98)	234 (2 studies)	⊕⊕⊝⊝ low^1,2
Pregnancy rate per couple ‐ 24 hours versus 48 hours	600 per 1000	398 per 1000 (130 to 742)	OR 0.44 (0.1 to 1.92)	30 (1 study)	⊕⊕⊝⊝ low^1,2
Pregnancy rate per couple ‐ 34 to 36 hours versus 48 hours	600 per 1000	465 per 1000 (174 to 788)	OR 0.58 (0.14 to 2.48)	30 (1 study)	⊕⊕⊝⊝ low^1,2
Miscarriage rate per pregnancy ‐ 24 hours versus 34 to 36 hours	116 per 1000	172 per 1000 (44 to 484)	OR 1.58 (0.35 to 7.16)	67 (2 studies)	⊕⊝⊝⊝ very low^1,3
Miscarriage rate per pregnancy ‐ 24 hours versus 48 hours	111 per 1000	333 per 1000 (33 to 880)	OR 4 (0.27 to 58.56)	15 (1 study)	⊕⊝⊝⊝ very low^1,3
Miscarriage rate per pregnancy ‐ 34 to 36 hours versus 48 hours	111 per 1000	142 per 1000 (9 to 764)	OR 1.33 (0.07 to 25.91)	16 (1 study)	⊕⊝⊝⊝ very low^1,2
The basis for the assumed risk* was the median control group risk across studies. 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.
¹Methods used for random sequence generation or allocation concealment were unclear. ²There was serious imprecision: findings were compatible with substantial benefit in the long interval group, or with no effect. (See comment) ³There was very serious imprecision, with very few events and wide confidence intervals

Summary of findings 3. Short interval compared to long interval for intrauterine insemination in subfertile couples

Ir a la tabla de la revisión

Summary of findings 4. hCG compared to GnRH‐a for intrauterine insemination in subfertile couples

hCG compared to GnRH‐a for intrauterine insemination in subfertile couples
Population: women undergoing intrauterine insemination Intervention: hCG Comparison: GnRH‐a
Outcomes	*Illustrative comparative risks (95% CI)**		Relative effect (95% CI)	No of participants (studies)	Quality of the evidence (GRADE)	Comments
	Assumed risk	Corresponding risk
	GnRH‐a	HCG
Live birth rate per couple	200 per 1000	206 per 1000 (95 to 390)	OR 1.04 (0.42 to 2.56)	104 (3 studies)	⊕⊕⊝⊝ low^1,2
Pregnancy rate per couple	315 per 1000	344 per 1000 (225 to 489)	OR 1.14 (0.63 to 2.08)	206 (4 studies)	⊕⊕⊝⊝ low^1,2
Multiple pregnancy rate per pregnancy	33 per 1000	5 per 1000 (1 to 45)	OR 0.15 (0.02 to 1.38)	74 (4 studies)	⊕⊝⊝⊝ very low^1,3
Miscarriage rate per pregnancy	124 per 1000	196 per 1000 (64 to 467)	OR 1.72 (0.48 to 6.2)	74 (4 studies)	⊕⊝⊝⊝ very low^1,3
OHSS per cycle	0 per 1000	0 per 1000 (0 to 0)	OR 2.27 (0.65 to 7.91)	456 (3 studies)	⊕⊕⊝⊝ low^1,2
The basis for the assumed risk* was the median control group risk across studies. 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.
¹Methods used for random sequence generation and allocation concealment were unclear. ²There was serious imprecision: findings were compatible with substantial benefit in either group, or with no effect. ³There was very serious imprecision, with very few events and wide confidence intervals.

Summary of findings 4. hCG compared to GnRH‐a for intrauterine insemination in subfertile couples

Ir a la tabla de la revisión

Summary of findings 5. Early hCG compared to late hCG for intrauterine insemination in subfertile couples

Early hCG compared to late hCG for intrauterine insemination in subfertile couples
Population: women undergoing intrauterine insemination Intervention: Early hCG Comparison: Late hCG
Outcomes	*Illustrative comparative risks (95% CI)**		Relative effect (95% CI)	No of participants (studies)	Quality of the evidence (GRADE)	Comments
	Assumed risk	Corresponding risk
	Late hCG	Early hCG
Pregnancy rate per couple	86 per 1000	110 per 1000 (68 to 175)	OR 1.32 (0.77 to 2.25)	612 (1 study)	⊕⊕⊝⊝ low^1,2
Miscarriage rate	103 per 1000	55 per 1000 (9 to 274)	OR 0.51 (0.08 to 3.28)	65 (1 study)	⊕⊝⊝⊝ very low^1,3
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.
¹Unclear risk of attrition bias. ²There was serious imprecision: findings were compatible with substantial benefit in the early hCG group, or with no effect. ³There was very serious imprecision, with very few events and wide confidence intervals.

Summary of findings 5. Early hCG compared to late hCG for intrauterine insemination in subfertile couples

Ir a la tabla de la revisión

Summary of findings 6. Differing dosages of hCG for intrauterine insemination in subfertile couples

Differing dosages of hCG for intrauterine insemination in subfertile couples
Population: women undergoing intrauterine insemination Intervention: differing dosages of hCG: 500 µg hCG versus 250 µg hCG
Outcomes	*Illustrative comparative risks (95% CI)**		Relative effect (95% CI)	No of participants (studies)	Quality of the evidence (GRADE)	Comments
	Assumed risk	Corresponding risk
	250 µg hCG	500 µg hCG
Pregnancy rate per couple	91 per 1000	121 per 1000 (27 to 402)	OR 1.38 (0.28 to 6.71)	66 (1 study)	⊕⊝⊝⊝ very low^1,2
The basis for the assumed risk* was the median control group risk across studies. 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.
¹Methods of random sequence generation and allocation concealment were unclear, high risk of attrition bias. ²There was very serious imprecision, with very few events and wide confidence intervals.

Summary of findings 6. Differing dosages of hCG for intrauterine insemination in subfertile couples

Ir a la tabla de la revisión

Comparison 1. hCG versus LH surge

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 live birth rate per couple Show forest plot	1	24	Odds Ratio (M‐H, Fixed, 95% CI)	1.0 [0.06, 18.08]

2 pregnancy rate per couple Show forest plot	4	275	Odds Ratio (M‐H, Fixed, 95% CI)	1.33 [0.72, 2.45]

3 multiple pregnancy rate per pregnancy Show forest plot	2	42	Odds Ratio (M‐H, Fixed, 95% CI)	1.13 [0.17, 7.60]

Comparison 1. hCG versus LH surge

Ir a la tabla de la revisión

Comparison 2. u‐hCG versus r‐hCG

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 live birth rate per couple Show forest plot	1		Odds Ratio (M‐H, Fixed, 95% CI)	Totals not selected

2 pregnancy rate per couple Show forest plot	2	409	Odds Ratio (M‐H, Fixed, 95% CI)	1.02 [0.65, 1.57]

3 multiple pregnancy rate per pregnancy Show forest plot	2	109	Odds Ratio (M‐H, Fixed, 95% CI)	0.99 [0.40, 2.47]

4 miscarriage rate per pregnancy Show forest plot	2	109	Odds Ratio (M‐H, Fixed, 95% CI)	0.57 [0.13, 2.47]

5 OHSS rate per cycle Show forest plot	2	468	Odds Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]

Comparison 2. u‐hCG versus r‐hCG

Ir a la tabla de la revisión

Comparison 3. Short versus long interval

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 live birth rate per couple Show forest plot	1		Odds Ratio (M‐H, Fixed, 95% CI)	Totals not selected

1.1 24 hours versus 34‐36 hours	1		Odds Ratio (M‐H, Fixed, 95% CI)	0.0 [0.0, 0.0]
2 pregnancy rate per couple Show forest plot	2		Odds Ratio (M‐H, Fixed, 95% CI)	Subtotals only

2.1 24 hours versus 34‐36 hours	2	234	Odds Ratio (M‐H, Fixed, 95% CI)	0.55 [0.31, 0.98]
2.2 24 hours versus 48 hours	1	30	Odds Ratio (M‐H, Fixed, 95% CI)	0.44 [0.10, 1.92]
2.3 34‐36 hours versus 48 hours	1	30	Odds Ratio (M‐H, Fixed, 95% CI)	0.58 [0.14, 2.48]
3 miscarriage rate per pregnancy Show forest plot	2		Odds Ratio (M‐H, Fixed, 95% CI)	Subtotals only

3.1 24 hours versus 34‐36 hours	2	67	Odds Ratio (M‐H, Fixed, 95% CI)	1.58 [0.35, 7.16]
3.2 24 hours versus 48 hours	1	15	Odds Ratio (M‐H, Fixed, 95% CI)	4.0 [0.27, 58.56]
3.3 34‐36 hours versus 48 hours	1	16	Odds Ratio (M‐H, Fixed, 95% CI)	1.33 [0.07, 25.91]

Comparison 3. Short versus long interval

Ir a la tabla de la revisión

Comparison 4. hCG versus GnRH‐a

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 live birth rate per couple Show forest plot	3	104	Odds Ratio (M‐H, Fixed, 95% CI)	1.04 [0.42, 2.56]

2 pregnancy rate per couple Show forest plot	4	206	Odds Ratio (M‐H, Fixed, 95% CI)	1.14 [0.63, 2.08]

3 multiple pregnancy rate per pregnancy Show forest plot	4	74	Odds Ratio (M‐H, Fixed, 95% CI)	0.15 [0.02, 1.38]

4 miscarriage rate per pregnancy Show forest plot	4	74	Odds Ratio (M‐H, Fixed, 95% CI)	1.72 [0.48, 6.20]

5 OHSS per cycle Show forest plot	3	456	Odds Ratio (M‐H, Fixed, 95% CI)	2.27 [0.65, 7.91]

Comparison 4. hCG versus GnRH‐a

Ir a la tabla de la revisión

Comparison 5. Early hCG versus late hCG

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 pregnancy rate per couple Show forest plot	1	612	Odds Ratio (M‐H, Fixed, 95% CI)	1.32 [0.77, 2.25]

2 miscarriage rate Show forest plot	1	65	Odds Ratio (M‐H, Fixed, 95% CI)	0.51 [0.08, 3.28]

Comparison 5. Early hCG versus late hCG

Ir a la tabla de la revisión

Comparison 6. Different dosages of hCG

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 pregnancy rate per couple Show forest plot	1	66	Odds Ratio (M‐H, Fixed, 95% CI)	1.38 [0.28, 6.71]

Comparison 6. Different dosages of hCG

Ir a la tabla de la revisión

The Cochrane Library

Scolaris Language Selector Scolaris Language Selector

Idioma de la Revisión Cochrane

Idioma de la web

Scolaris Content Language Banner Portlet Scolaris Content Language Banner Portlet