Optimizing intrauterine insemination: A systematic review and meta‐analysis of the effectiveness and safety of clinical treatment add‐ons
Abstract Introduction Intrauterine insemination (IUI) is one of the most widespread fertility treatments. However, IUI protocols vary significantly amongst fertility clinics. Various add‐on interventions have been proposed to boost success rates. These are mostly chosen arbitrarily or empirically. T...
Saved in:
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2024-10-01
|
| Series: | Acta Obstetricia et Gynecologica Scandinavica |
| Subjects: | |
| Online Access: | https://doi.org/10.1111/aogs.14858 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849422846561878016 |
|---|---|
| author | Elpiniki Chronopoulou Andrea Gaetano‐Gil Sadaf Shaikh Claudia Raperport Bassel H. Al Wattar Gabriel Ruiz‐Calvo Javier Zamora Priya Bhide |
| author_facet | Elpiniki Chronopoulou Andrea Gaetano‐Gil Sadaf Shaikh Claudia Raperport Bassel H. Al Wattar Gabriel Ruiz‐Calvo Javier Zamora Priya Bhide |
| author_sort | Elpiniki Chronopoulou |
| collection | DOAJ |
| description | Abstract Introduction Intrauterine insemination (IUI) is one of the most widespread fertility treatments. However, IUI protocols vary significantly amongst fertility clinics. Various add‐on interventions have been proposed to boost success rates. These are mostly chosen arbitrarily or empirically. The aim of this systematic review and meta‐analysis is to assess the effectiveness and safety of add‐on interventions to the standard IUI protocol and to provide evidence‐based recommendations on techniques used to optimize the clinical outcomes of IUI treatment. Material and Methods Systematic review and meta‐analyses were performed in accordance with PRISMA guidelines. A computerized literature search was performed from database inception to May 2023. Randomized controlled trials (RCTs) were included reporting on couples/single women undergoing IUI with any protocol for any indication using partner's or donor sperm. A meta‐analysis based on random effects was performed for each outcome and add‐on. Three authors independently assessed the trials for quality and risk of bias and overall certainty of evidence. Uncertainties were resolved through consensus. Primary outcomes were ongoing pregnancy rate (OPR) or live birth rate (LBR) per cycle/per woman randomized. Registration number PROSPERO: CRD42022300857. Results Sixty‐six RCTs were included in the analysis (16 305 participants across 20 countries). Vaginal progesterone as luteal phase support in stimulated cycles was found to significantly increase LBR/OPR (RR 1.37, 95% CI 1.09–1.72, I2 = 4.9%) (moderate/low certainty of the evidence). Endometrial scratch prior/during stimulated IUI cycles may increase LBR/OPR (RR 1.44, 95% CI 1.03–2.01, I2 = 1.8%), but evidence is very uncertain. Results from two studies suggest that follicular phase ovarian stimulation increases LBR/OPR (RR 1.39, 95% CI 1.00–1.94, I2 = 0%) (low certainty of evidence). No significant difference was seen for the primary outcome for the other studied interventions. Conclusions The findings of this systematic review and meta‐analysis suggest that vaginal luteal phase progesterone support probably improves LBR/OPR in stimulated IUI treatments. In view of moderate/low certainty of the evidence more research is needed for solid conclusions. Further research is also recommended for the use of endometrial scratch and ovarian stimulation. Future studies should report on results according to subfertility background as it is possible that different add‐ons could benefit specific patient groups. |
| format | Article |
| id | doaj-art-088214c97ea94d67b438f11e2aa5a19a |
| institution | Kabale University |
| issn | 0001-6349 1600-0412 |
| language | English |
| publishDate | 2024-10-01 |
| publisher | Wiley |
| record_format | Article |
| series | Acta Obstetricia et Gynecologica Scandinavica |
| spelling | doaj-art-088214c97ea94d67b438f11e2aa5a19a2025-08-20T03:30:53ZengWileyActa Obstetricia et Gynecologica Scandinavica0001-63491600-04122024-10-01103101919193210.1111/aogs.14858Optimizing intrauterine insemination: A systematic review and meta‐analysis of the effectiveness and safety of clinical treatment add‐onsElpiniki Chronopoulou0Andrea Gaetano‐Gil1Sadaf Shaikh2Claudia Raperport3Bassel H. Al Wattar4Gabriel Ruiz‐Calvo5Javier Zamora6Priya Bhide7The Center for Reproductive and Genetic Health (CRGH) London UKClinical Biostatistics Unit Hospital Universitario Ramon y Cajal (IRYCIS) Madrid SpainCREATE Fertility London UKLondon North West University Healthcare NHS Trust London UKInstitute for Women's Health University College London London UKClinical Biostatistics Unit Hospital Universitario Ramon y Cajal (IRYCIS) Madrid SpainClinical Biostatistics Unit Hospital Universitario Ramon y Cajal (IRYCIS) Madrid SpainWomen's Health Research Unit, Wolfson Institute of Population Health Queen Mary University of London London UKAbstract Introduction Intrauterine insemination (IUI) is one of the most widespread fertility treatments. However, IUI protocols vary significantly amongst fertility clinics. Various add‐on interventions have been proposed to boost success rates. These are mostly chosen arbitrarily or empirically. The aim of this systematic review and meta‐analysis is to assess the effectiveness and safety of add‐on interventions to the standard IUI protocol and to provide evidence‐based recommendations on techniques used to optimize the clinical outcomes of IUI treatment. Material and Methods Systematic review and meta‐analyses were performed in accordance with PRISMA guidelines. A computerized literature search was performed from database inception to May 2023. Randomized controlled trials (RCTs) were included reporting on couples/single women undergoing IUI with any protocol for any indication using partner's or donor sperm. A meta‐analysis based on random effects was performed for each outcome and add‐on. Three authors independently assessed the trials for quality and risk of bias and overall certainty of evidence. Uncertainties were resolved through consensus. Primary outcomes were ongoing pregnancy rate (OPR) or live birth rate (LBR) per cycle/per woman randomized. Registration number PROSPERO: CRD42022300857. Results Sixty‐six RCTs were included in the analysis (16 305 participants across 20 countries). Vaginal progesterone as luteal phase support in stimulated cycles was found to significantly increase LBR/OPR (RR 1.37, 95% CI 1.09–1.72, I2 = 4.9%) (moderate/low certainty of the evidence). Endometrial scratch prior/during stimulated IUI cycles may increase LBR/OPR (RR 1.44, 95% CI 1.03–2.01, I2 = 1.8%), but evidence is very uncertain. Results from two studies suggest that follicular phase ovarian stimulation increases LBR/OPR (RR 1.39, 95% CI 1.00–1.94, I2 = 0%) (low certainty of evidence). No significant difference was seen for the primary outcome for the other studied interventions. Conclusions The findings of this systematic review and meta‐analysis suggest that vaginal luteal phase progesterone support probably improves LBR/OPR in stimulated IUI treatments. In view of moderate/low certainty of the evidence more research is needed for solid conclusions. Further research is also recommended for the use of endometrial scratch and ovarian stimulation. Future studies should report on results according to subfertility background as it is possible that different add‐ons could benefit specific patient groups.https://doi.org/10.1111/aogs.14858add‐onsbed restinseminationIUIprogesteronescratch |
| spellingShingle | Elpiniki Chronopoulou Andrea Gaetano‐Gil Sadaf Shaikh Claudia Raperport Bassel H. Al Wattar Gabriel Ruiz‐Calvo Javier Zamora Priya Bhide Optimizing intrauterine insemination: A systematic review and meta‐analysis of the effectiveness and safety of clinical treatment add‐ons Acta Obstetricia et Gynecologica Scandinavica add‐ons bed rest insemination IUI progesterone scratch |
| title | Optimizing intrauterine insemination: A systematic review and meta‐analysis of the effectiveness and safety of clinical treatment add‐ons |
| title_full | Optimizing intrauterine insemination: A systematic review and meta‐analysis of the effectiveness and safety of clinical treatment add‐ons |
| title_fullStr | Optimizing intrauterine insemination: A systematic review and meta‐analysis of the effectiveness and safety of clinical treatment add‐ons |
| title_full_unstemmed | Optimizing intrauterine insemination: A systematic review and meta‐analysis of the effectiveness and safety of clinical treatment add‐ons |
| title_short | Optimizing intrauterine insemination: A systematic review and meta‐analysis of the effectiveness and safety of clinical treatment add‐ons |
| title_sort | optimizing intrauterine insemination a systematic review and meta analysis of the effectiveness and safety of clinical treatment add ons |
| topic | add‐ons bed rest insemination IUI progesterone scratch |
| url | https://doi.org/10.1111/aogs.14858 |
| work_keys_str_mv | AT elpinikichronopoulou optimizingintrauterineinseminationasystematicreviewandmetaanalysisoftheeffectivenessandsafetyofclinicaltreatmentaddons AT andreagaetanogil optimizingintrauterineinseminationasystematicreviewandmetaanalysisoftheeffectivenessandsafetyofclinicaltreatmentaddons AT sadafshaikh optimizingintrauterineinseminationasystematicreviewandmetaanalysisoftheeffectivenessandsafetyofclinicaltreatmentaddons AT claudiaraperport optimizingintrauterineinseminationasystematicreviewandmetaanalysisoftheeffectivenessandsafetyofclinicaltreatmentaddons AT basselhalwattar optimizingintrauterineinseminationasystematicreviewandmetaanalysisoftheeffectivenessandsafetyofclinicaltreatmentaddons AT gabrielruizcalvo optimizingintrauterineinseminationasystematicreviewandmetaanalysisoftheeffectivenessandsafetyofclinicaltreatmentaddons AT javierzamora optimizingintrauterineinseminationasystematicreviewandmetaanalysisoftheeffectivenessandsafetyofclinicaltreatmentaddons AT priyabhide optimizingintrauterineinseminationasystematicreviewandmetaanalysisoftheeffectivenessandsafetyofclinicaltreatmentaddons |