Synchronised approach for intrauterine insemination in subfertile couples.
Synchronised approach for intrauterine insemination in subfertile couples.
复制标题
生育力低下夫妇宫内授精的同步方法。
DOI：
10.1002/14651858.cd006942.pub2
复制
发表时间：
2010
期刊：
影响因子：
--
通讯作者：
B. Cohlen
中科院分区：
文献类型：
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作者：
A. Cantineau;M. Janssen;B. Cohlen
背景
子宫内授精（IUI）应该在排卵前后进行。由于精子和卵母细胞只有有限的存活时间，正确的时间是必不可少的。由于目前尚不清楚哪种IUI定时技术可获得最佳治疗结果，因此我们比较了不同的IUI定时技术和不同的时间间隔。
目标
评价自然周期和刺激周期中不同同步方法对低生育力夫妇IUI的有效性。
搜索策略
我们检索了所有描述IUI时机的随机对照试验的出版物。我们检索了科克伦月经失调和生育力低下组专业注册中心、科克伦对照试验中心（CENTRAL）（科克伦图书馆）（1966年至2009年3月）、EMBASE（1974年至2009年3月）和Science Direct（1966年至2009年3月）电子数据库。此外，我们检查了所有获得的研究的参考文献列表，并对会议摘要进行了手工检索。
选择标准
仅纳入了比较不同IUI时间方法的真正随机对照试验。评价了以下干预措施：检测尿液或血液中的促黄体生成激素（LH），单次检测;人绒毛膜促性腺激素（hCG）给药; LH检测和hCG给药联合;基础体温图;超声检测排卵;促性腺激素释放激素（GnRH）激动剂给药;或其他定时方法。
数据收集和分析
两名综述作者根据上述标准独立选择纳入的试验。我们按照科克伦协作网制定的统计分析指南进行统计分析。
主要结果
纳入了10项比较尿LH峰与hCG注射、重组hCG与尿hCG以及hCG与GnRH激动剂的研究。一项研究比较了从hCG注射到IUI的最佳时间间隔。这些研究的结果显示，IUI的不同计时方法（以活产率表示）之间无显著差异：hCG vs LH峰（比值比（OR）1.0，95% CI 0.06 - 18）;尿hCG vs重组hCG（OR 1.2，95% CI 0.68 - 2.0）; hCG vs GnRH激动剂（OR 1.1，95% CI 0.42 - 3.1）。分析的所有次要结局均显示治疗组间无显著差异。
作者的结论
没有证据表明一种特定的治疗方案优于另一种。选择应基于医院设施、对病人的便利性、医务人员、成本和辍学率。由于hCG和IUI之间的不同时间间隔不会导致不同的妊娠率，因此可以采用更灵活的方法。
BACKGROUND
Intrauterine insemination (IUI) should logically be performed around the moment of ovulation. Since spermatozoa and oocytes have only limited survival times correct timing is essential. As it is not known which technique of timing for IUI results in the best treatment outcome, we compared different techniques for timing IUI and different time intervals.
OBJECTIVES
To evaluate the effectiveness of different synchronisation methods in natural and stimulated cycles for IUI in subfertile couples.
SEARCH STRATEGY
We searched for all publications which described randomised controlled trials of the timing of IUI. We searched the Cochrane Menstrual Disorders and Subfertility Group Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library), (1966 to March 2009), EMBASE (1974 to March 2009) and Science Direct (1966 to March 2009) electronic databases. Furthermore, we checked the reference lists of all obtained studies and performed a handsearch of conference abstracts.
SELECTION CRITERIA
Only truly randomised controlled trials comparing different timing methods for IUI were included. The following interventions were evaluated: detection of luteinising hormone (LH) in urine or blood, single test; human chorionic gonadotropin (hCG) administration; combination of LH detection and hCG administration; basal body temperature chart; ultrasound detection of ovulation; gonadotropin-releasing hormone (GnRH) agonist administration; or other timing methods.
DATA COLLECTION AND ANALYSIS
Two review authors independently selected the trials to be included according to the above mentioned criteria. We performed statistical analyses in accordance with the guidelines for statistical analysis developed by The Cochrane Collaboration.
MAIN RESULTS
Ten studies were included comparing urinary LH surge versus hCG injection; recombinant hCG versus urinary hCG; and hCG versus a GnRH agonist. One study compared the optimum time interval from hCG injection to IUI. The results of these studies showed no significant differences between different timing methods for IUI expressed as live birth rates: hCG versus LH surge (odds ratio (OR) 1.0, 95% CI 0.06 to 18); urinary hCG versus recombinant hCG (OR 1.2, 95% CI 0.68 to 2.0); and hCG versus GnRH agonist (OR 1.1, 95% CI 0.42 to 3.1). All the secondary outcomes analysed showed no significant differences between treatment groups.
AUTHORS' CONCLUSIONS
There is no evidence to advise one particular treatment option over another. The choice should be based on hospital facilities, convenience for the patient, medical staff, costs and drop-out levels. Since different time intervals between hCG and IUI did not result in different pregnancy rates, a more flexible approach might be allowed.