Human Reproduction, Vol 12, 1865-1872, Copyright © 1997 by Oxford University Press
EG Hughes
A systematic review was conducted to evaluate the effectiveness of
intrauterine insemination (IUI) with or without ovarian stimulation using
gonadotrophin in the treatment of persistent infertility. Relevant
randomized controlled trials were identified by a diverse strategy
including a hand search of 43 core journals from 1966 to the present. Two
approaches to meta-analysis were used to summarize data. First, using a
standard Mantel-Haenszel approach, eight trials comparing FSH/IUI with
FSH/timed intercourse for unexplained infertility were combined. The common
odds ratio for pregnancy was 2.37 [95% confidence interval (CI), 1.43,
3.90], suggesting a significant improvement with IUI following ovulation
induction in this patient group. Although the data were statistically
homogeneous, clinically important heterogeneity was present. Second, across
all diagnostic groups, the independent effects of treatment with follicle
stimulating hormone (FSH), clomiphene citrate, IUI, as well as the
diagnoses of male factor and endometriosis were assessed using stepwise
logistic regression. Based on 5214 cycles reported in 22 trials, the odds
ratio for pregnancy associated with FSH use was 2.35 (95% CI, 1.87, 2.94)
for IUI, 2.82 (95% CI, 2.18, 3.66) for male factor, 0.48 (95% CI, 0.37,
0.61), and for endometriosis 0.45 (95% CI, 0.27, 0.76). This summary of the
best available evidence may prove useful in counselling couples who are
considering FSH and/or IUI therapy.
REVIEWS
The effectiveness of ovulation induction and intrauterine insemination in the treatment of persistent infertility: a meta-analysis
Department of Obstetrics and Gynaecology, McMaster University, Hamilton, Ontario, Canada.
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