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Human Reproduction, Vol. 8, No. 8, pp. 1209-1222, 1993
© 1993 European Society of Human Reproduction and Embryology

research-article

Infertility:Treatment of male infertility: is it effective? Review and meta-analyses of published randomized controlled trials

Patricia A. O'Donovan, Patrick Vandekerckhove1, Richard J. Lilford and Edward Hughes2

Institute of Epidemiology and Health Services Research, University of Leeds 34 Hyde Terrace, Leeds LS2 9LN, UK 2McMaster University Hamilton, Ontario, Canada

Correspondence: 1To whom correspondence should be addressed

There are few widely accepted treatments for male subfertility. Controlled trials are necessary to evaluate different subfertility treatments because pregnancies and spontaneous improvements in semen parameters occur without treatment. Properly randomized trials can find out whether pregnancy rates are higher or lower than expected after treatment. Quantitative meta-analysis improves precision where individual trials are not powerful enough to demonstrate moderate treatment effects. Only 174 published randomized treatment trials for male subfertility were found after extensive literature review, both by computerized search and hand searches of 41 journals. In 72 of the studies, pregnancy was an outcome measure and these are analysed and discussed. The quality of most trials is poor. Meta-analysis was possible on seven themes, but the results of this exercise appear to be unduly influenced by trials of poor quality. Few conventional treatments (i.e. those not involving assisted conception techniques) result in improved fertility rates.

Key words: effectiveness of care/male infertility/meta-analysis/random allocation/randomized trials


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