Intra-uterine insemination for unexplained subfertility.
Intra-uterine insemination for unexplained subfertility.
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DOI：
10.1002/14651858.cd001838.pub2
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发表时间：
2006
期刊：
影响因子：
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通讯作者：
S. M. Veltman-Verhulst;B. Cohlen;E. Hughes;M. Heineman;Jane Farquhar;Anne Marjoribanks;Lethaby statistician;Andy
中科院分区：
文献类型：
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作者：
S. M. Veltman-Verhulst;B. Cohlen;E. Hughes;M. Heineman;Jane Farquhar;Anne Marjoribanks;Lethaby statistician;Andy
背景技术宫内人工授精（IUI）是一种广泛用于治疗不明原因生育力低下的夫妇的生育治疗方法。尽管 IUI 比体外受精 (IVF) 侵入性更小且成本更低，但 IUI 与卵巢过度刺激 (OH) 联合使用的安全性仍存在争议。对 OH 进行 IUI 治疗的主要担忧是多胎妊娠率的增加。目的 确定对于不明原因不孕症的夫妇，在有或没有卵巢过度刺激的情况下，与定时性交 (TI) 相比，IUI 是否可以提高活产率。检索策略 我们检索了 Cochrane 月经失调和生育力低下组试验登记册（2005 年 3 月检索）、Cochrane 对照试验中央登记册（Cochrane 图书馆 2005 年第 4 期）、MEDLINE（1966 年至 2005 年 11 月）、EMBASE（1980 年至 2005 年 11 月）、SCIsearch 和文章参考列表。我们联系了已确定研究的作者，以了解缺失或未发表的数据。选择标准 真正的随机对照试验 (RCT) 至少包含以下一项比较： --IUI 与 TI，均处于自然周期； --IUI 与 TI，均处于刺激周期； --自然周期中的 IUI 与刺激周期中的 IUI； --自然周期中 OH 与 TI 的 IUI； --自然周期中的 IUI 与 OH 中的 TI 对比。仅包括不明原因生育力低下的夫妇。数据收集和分析 质量评估和数据提取由两位综述作者独立进行。提取结果并汇总数据。尽可能进行亚组分析和敏感性分析。主要结果 在刺激周期中将 IUI 与 TI 进行比较的六项试验中，有证据表明怀孕的机会增加（六项随机对照试验，517 名女性：OR 1.68，95% CI 1.13 至 2.50）。与自然周期中的 IUI 相比，同时进行 OH 的 IUI 的女性的妊娠率也显着增加（三项随机对照试验，415 名女性：OR 2.33，95% CI 1.46 至 3.71）。然而，这些试验没有提供足够的数据来调查有或没有 OH 的 IUI 对几个重要结局的影响，包括活产、多胎妊娠、流产和卵巢过度刺激的风险。没有证据表明自然周期中 IUI 与 OH 与 TI 的妊娠率存在差异（一项随机对照试验，51 名女性：OR 4.05，95% CI 0.39 至 41.87）。没有发现其他两项比较的随机对照试验。作者的结论 有证据表明，与单独 IUI 相比，IUI 联合 OH 可以提高活产率。在刺激周期中，与 TI 治疗相比，IUI 治疗的怀孕可能性也有所增加。关于 OH 治疗的多胎妊娠和其他不良事件的数据不足。因此，夫妇应充分了解 IUI 和 OH 的风险以及替代治疗方案。
BACKGROUND Intra-uterine insemination (IUI) is a widely used fertility treatment for couples with unexplained subfertility. Although IUI is less invasive and less expensive than in vitro fertilisation (IVF), the safety of IUI in combination with ovarian hyperstimulation (OH) is debated. The main concern about IUI treatment with OH is the increase in multiple pregnancy rates. OBJECTIVES To determine whether for couples with unexplained subfertility IUI improves the live birth rate compared with timed intercourse (TI), both with and without ovarian hyperstimulation. SEARCH STRATEGY We searched the Cochrane Menstrual Disorder and Subfertility Group Trials Register (searched March 2005), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2005, Issue 4), MEDLINE (1966 to November 2005), EMBASE (1980 to November 2005), SCIsearch and reference lists of articles. Authors of identified studies were contacted for missing or unpublished data. SELECTION CRITERIA Truly randomised controlled trials (RCTs) with at least one of the following comparisons were included: --IUI versus TI, both in a natural cycle; --IUI versus TI, both in a stimulated cycle; --IUI in a natural cycle versus IUI in a stimulated cycle; --IUI with OH versus TI in natural cycle; --IUI in a natural cycle versus TI with OH. Only couples with unexplained subfertility were included. DATA COLLECTION AND ANALYSIS Quality assessment and data extraction were performed independently by two review authors. Outcomes were extracted and the data were pooled. Subgroup analyses and sensitivity analyses were done where possible. MAIN RESULTS In the six trials where IUI was compared with TI, both in stimulated cycles, there was evidence of an increased chance of pregnancy (six RCTs, 517 women: OR 1.68, 95% CI 1.13 to 2.50). A significant increase in pregnancy rate was also found for women where IUI with OH was compared with IUI in a natural cycle (three RCTs, 415 women: OR 2.33, 95% CI 1.46 to 3.71). However, the trials provided insufficient data to investigate the impact of IUI with or without OH on several important outcomes including live birth, multiple pregnancies, miscarriage and risk of ovarian hyperstimulation. There was no evidence of a difference in pregnancy rate for IUI with OH compared with TI in a natural cycle (one RCT, 51 women: OR 4.05, 95% CI 0.39 to 41.87). No RCTs were found for the other two comparisons. AUTHORS' CONCLUSIONS There is evidence that IUI with OH increases the live birth rate compared to IUI alone. The likelihood of pregnancy was also increased for treatment with IUI compared to TI both in stimulated cycles. There is insufficient data on multiple pregnancies and other adverse events for treatment with OH. Therefore, couples should be fully informed about the risks of IUI and OH as well as alternative treatment options.