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Intra-uterine insemination for male subfertility
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机译：宫腔内人工授精治疗男性不育症
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BACKGROUND: Intra-uterine insemination (IUI) is one of the most frequently used fertility treatments for couples with male subfertility. Its use, especially when combined with ovarian hyperstimulation (OH) has been subject of discussion. Although the treatment itself is less invasive and expensive than others, its efficacy has not been proven. Furthermore, the adverse effects of OH such as ovarian hyperstimulation syndrome (OHSS ) and multiple pregnancy are a concern. OBJECTIVES: The aim of this review was to determine whether for couples with male subfertility, IUI improves the live birth rates or ongoing pregnancy rates compared with timed intercourse (TI), with or without OH. SEARCH STRATEGY: We searched the Cochrane Menstrual and Disorders Subfertility Group Trials Special Register, the Cochrane Central Register of Controlled Trials (the Cochrane Library, 2006, issue 3), MEDLINE (1966 to May 2006), EMBASE (1980 to May 2006), SCIsearch and the reference lists of articles. We hand searched abstracts of the American Society for Reproductive Medicine, the European Society for Human Reproduction and Embryology. Authors of identified articles were contacted for unpublished data. SELECTION CRITERIA: Randomised controlled trials (RCT's) with at least one of the following comparisons were included: 1) IUI versus TI or expectant management both in natural cycles 2) IUI versus TI both in cycles with OH 3) IUI in natural cycles versus TI + OH 4) IUI + OH versus TI in natural cycles 5) IUI in natural cycles versus IUI + OH. Couples with abnormal sperm parameters only were included. DATA COLLECTION AND ANALYSIS: Two co-reviewers independently performed quality assessment and data extraction. Where possible data were pooled, and a meta-analysis was performed. Sensitivity and subgroup analyses were carried out where possible and appropriate. MAIN RESULTS: Three trials of parallel design, and five trials of cross-over design with pre-cross-over data were included in the meta-analysis.Three compared IUI with TI both in stimulated cycles.The remaining four of these studies compared IUI versus IUI + OH . Three studies reported on our main outcome of interest live birth rate per couple.For the comparison IUI versus TI both in natural cycles no evidence of difference between the probabilities of pregnancy rates per woman after IUI compared with TI was found (Peto OR 5.3, 95% CI 0.42 to 67). No statistically significant of difference between pregnancy rates (PR) per couple for IUI + OH versus IUI could be found (Peto OR 1.47, 95% CI 0.92 to 2.37). For the comparison IUI versus TI both in stimulated cycles there was no evidence of statistically significant difference in pregnancy rates per couple either (Peto OR 1.67, 95% CI 0.83 to 3.37). There were insufficient data available for adverse outcomes such as OHSS, multiple pregnancy, miscarriage rate and ectopic pregnancy to perform a statistical analysis. For the other two comparisons no RCT's were found which reported pregnancy rates per couple. A further 10 studies which included one of the comparisons of interests were found. Since these studies reported pregnancy rates per cycle only these data could not be included in the meta-analysis. AUTHORS' CONCLUSIONS: There was insufficient evidence of effectiveness to recommend or advise against IUI with or without OH above TI, or vice versa. Large, high quality randomised controlled trials, comparing IUI with or without OH with pregnancy rate per couple as the main outcome of interest are lacking. There is a need for such trials since firm conclusions cannot be drawn yet
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机译：背景：宫内授精（IUI）是男性不育症夫妇最常用的生育治疗方法之一。它的使用，尤其是与卵巢过度刺激（OH）结合使用时，已经成为讨论的主题。尽管该治疗方法本身比其他方法具有较低的侵入性和昂贵性，但其疗效尚未得到证实。此外，OH的不利影响，例如卵巢过度刺激综合症（OHSS）和多胎妊娠也是一个令人关注的问题。目的：本综述的目的是确定与有或没有OH的定时性交（TI）相比，对于有男性不育症的夫妇，IUI是提高活产率还是持续妊娠率。搜索策略：我们搜索了Cochrane月经和疾病亚生育组试验特别登记册，Cochrane对照试验中央登记册（Cochrane图书馆，2006年，第3期），MEDLINE（1966年至2006年5月），EMBASE（1980年至2006年5月）， SCIsearch和参考文献列表。我们手工搜索了美国生殖医学学会，欧洲人类生殖与胚胎学学会的摘要。与确定文章的作者联系以获取未发表的数据。选择标准：包括至少具有以下一项比较的随机对照试验（RCT）：1）自然周期中的IUI与TI或预期管理2）OH周期中的IUI与TI两者均3）自然周期中的IUI与TI + OH 4）自然循环中IUI + OH与TI的关系5）自然循环中IUI与IUI + OH的关系。仅包括异常精子参数的夫妇。数据收集和分析：两名共同审核员独立进行质量评估和数据提取。汇总可能的数据，并进行荟萃分析。在可能和适当的地方进行敏感性和亚组分析。主要结果：荟萃分析包括三项并行设计试验和五项具有预交叉数据的交叉设计试验，其中三项在刺激周期中将IUI与TI进行了比较，其余四项研究则对IUI进行了比较与IUI + OH相比。三项研究报告了我们每对夫妇的实际活产率的主要结果。在自然周期中比较IUI与TI的情况，均未发现IUI与TI相比，每位妇女的妊娠率概率存在差异的证据（Peto OR 5.3，95 ％CI 0.42至67）。没有发现IUI + OH与IUI的每对夫妇怀孕率（PR）之间的统计学差异（Peto OR 1.47，95％CI 0.92至2.37）。对于在刺激周期中的IUI与TI进行比较，均没有证据显示每对夫妇的妊娠率有统计学上的显着差异（Peto OR 1.67，95％CI 0.83至3.37）。没有足够的数据用于OHSS，多胎妊娠，流产率和异位妊娠等不良后果进行统计学分析。对于其他两个比较，未发现报告每对夫妇怀孕率的RCT。还发现了另外10项研究，其中包括利益比较之一。由于这些研究报告了每个周期的妊娠率，因此只有这些数据不能纳入荟萃分析。作者的结论：没有足够的证据证明对有或没有OH高于TI的IUI进行推荐或建议的有效性，反之亦然。目前尚缺乏大型，高质量的随机对照试验，缺乏将有或没有OH的IUI与每对夫妇的妊娠率作为主要研究结果的比较。由于尚不能得出肯定的结论，因此需要进行此类试验。
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