Intrauterine insemination + controlled ovarian hyperstimulation versus in vitro fertilisation in unexplained infertility: a systematic review and meta-analysis

2021 ◽  
Author(s):  
Anupa Nandi ◽  
Gangopadhyay Raja ◽  
Davinia White ◽  
El-Toukhy Tarek
Keyword(s):  
Systematic Review ◽  
Intrauterine Insemination ◽  
Meta Analysis ◽  
Controlled Ovarian Hyperstimulation ◽  
Unexplained Infertility ◽  
In Vitro Fertilisation ◽  
Ovarian Hyperstimulation

scholarly journals Controlled ovarian hyperstimulation for poor ovarian responders undergoing in vitro fertilisation/intracytoplasmic sperm injection: a protocol for systematic review and Bayesian network meta-analysis

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e039122
Author(s):  
Huisheng Yang ◽  
Chensi Zheng ◽  
Qiyan Zheng ◽  
Huanfang Xu ◽  
Xiaotong Li ◽  
...  
Keyword(s):  
Pregnancy Rate ◽  
Intracytoplasmic Sperm Injection ◽  
Ovarian Stimulation ◽  
Meta Analysis ◽  
Ovarian Response ◽  
Controlled Ovarian Hyperstimulation ◽  
In Vitro Fertilisation ◽  
Ovarian Hyperstimulation ◽  
Poor Ovarian Responders

IntroductionControlled ovarian hyperstimulation (COH) is the routine regimen used to generate a sufficient number of follicles during in vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI) treatment. Poor ovarian response is a challenge encountered by many clinicians during COH and poor ovarian responders (PORs) usually have higher follicle stimulating hormone levels, lower levels of anti-Mullerian hormone and few oocytes retrieved, which have been attributed mainly to advanced maternal age and poor follicle reserve or other reasons that could impair ovarian response during ovarian stimulation. Over the last few decades, researchers have proposed a series of strategies and ovarian stimulation protocols to improve pregnancy outcomes in patients with POR during their IVF/ICSI treatment. However, clinical decisions regarding COH protocols in PORs during IVF/ICSI treatment remain controversial. Traditional pairwise meta-analysis only allows the direct comparison of two protocols in COH for patients with POR. However, many of these COH protocols have not been compared directly in randomised controlled trials (RCTs). Thus, we aim to use network meta-analysis (NMA) to assess the clinical effectiveness and safety of COH protocols and to generate treatment rankings of these COH protocols for the most clinically important and commonly reported outcomes events.Methods and analysisThe PubMed, Embase, Cochrane Library, Web of Science, SinoMed, CNKI, WanFang database and Chongqing VIP information databases will be searched for all RCTs of COH for POR women during IVF/ICSI from inception to 31 March 2020. Primary outcomes will include live birth rate and number of oocytes retrieved. Secondary outcomes will include ongoing pregnancy rate, clinical pregnancy rate, miscarriage rate, ovarian hyperstimulation syndrome rate, multiple pregnancy rate and cycle cancellation rate. Pairwise meta-analysis and Bayesian NMA will be conducted for each outcome. Subgroup analysis, meta-regression, and sensitivity analysis will be performed to assess the robustness of the findings. The generation of NMA plots and subsequent results will be performed by using R V.4.0.1. The assessment of confidence in network estimates will use the Confidence in Network Meta-Analysis)web application (see https://cinema.ispm.unibe.ch/).Ethics and disseminationThis review does not require ethics approval and the results of the NMA will be submitted to a peer-review journal.

scholarly journals Comparison of intrauterine insemination and timed intercourse following controlled ovarian hyperstimulation in unexplained infertility: a randomized controlled trial

2019 ◽  
Vol 8 (3) ◽  
pp. 1035
Author(s):  
Sayanti Paul ◽  
Saumen Mandal ◽  
Arghya Pal ◽  
Sumit Ranjan Pramanik
Keyword(s):  
Randomized Controlled Trial ◽  
Intrauterine Insemination ◽  
Controlled Trial ◽  
Controlled Ovarian Hyperstimulation ◽  
Unexplained Infertility ◽  
Clinical Pregnancy ◽  
Ovarian Hyperstimulation ◽  
Randomized Controlled ◽  
Group 2 ◽  
Group 1

Background: Being a diagnosis of exclusion the treatment options of unexplained infertility are often empiric. There is significant dilemma regarding the superiority of one over another. Despite increasing use of intrauterine insemination (IUI) in adjunct to controlled ovarian hyperstimulation (COH) there is scarcity of randomized controlled trials (RCT) from developing countries. Objective was to compare IUI and timed intercourse (TI) in super ovulated cycles among couples with unexplained infertility over one year.Methods: In this prospective randomized controlled trial total 85 patients were randomly assigned into group 1 (COH with IUI, N= 44) and group 2 (COH with TI, N=41). Patients underwent COH using sequential Clomiphene Citrate and injection human menopausal gonadotrophin followed by IUI in group 1 and timed intercourse in group 2. Either protocol was repeated for three consecutive cycles. Finally, both groups were compared for clinical pregnancy rate, adverse effects and acceptability of the treatment process and outcome. Comparison was done by Student’s unpaired t test for continuous and 2-tailed chi square test for categorical variables.Results: Clinical pregnancy rates following COH/IUI and COH/TI were 13.64% and 19.51% respectively. There was observable difference in the acceptability of the outcome (38.64% in IUI and 56.09% in TI group). All the results including complications and side effect rates were statistically insignificant.Conclusions: Present study failed to show any improvement of pregnancy rates following addition of IUI over TI and it raised the probability that the outcome of the procedure may not be well accepted.

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