In vitro fertilisation for unexplained subfertility

Abstract

BackgroundOne-third of subfertile couples have no identifiable cause for their inability to conceive. In vitro fertilisation (IVF) is a widely accepted treatment for this condition; however, this treatment is invasive and expensive and is associated with risks. ObjectivesTo evaluate the e ectiveness and safety of IVF compared with expectant management, unstimulated intrauterine insemination (IUI) or intrauterine insemination along with ovarian stimulation with gonadotropins (IUI + gonadotropins) or clomiphene (IUI + CC) or letrozole (IUI + letrozole) in improving pregnancy outcomes. Search methodsThis review has drawn on the search strategy developed by the Cochrane Menstrual Disorders and Subfertility Group. We searched the

A randomised controlled trial of intra-uterine insemination versusin vitrofertilisation in patients with idiopathic or mild male infertility

“…The results also demonstrated that the cost per live birth for IVF was less than that for IUI. Our results differ from those of older comparisons of IUI and IVF, but there is heterogeneity between these studies . More recent studies have also produced variable results.…”

“…Furthermore Pandian et al . found a higher multiple pregnancy rate in women who underwent SO/IUI compared with IVF, but this did not reach statistical significance …”

“…trial involved 122 couples. The live birth rates were 9% for IUI and 13% for IVF, with IUI 2.4 times more cost‐effective . Some previous practice guidelines recommend IVF for poorly explained infertility only after IUI has been unsuccessful .…”

“…Some previous practice guidelines recommend IVF for poorly explained infertility only after IUI has been unsuccessful . While current NICE guidelines (2013) recommend IVF for couples with poorly explained infertility, a recent updated Cochrane review in 2012 failed to recommend one treatment over the other due to insufficient RCT evidence on live birth rates, adverse outcomes and costs. In the light of the significant improvement in live birth rates with IVF over the last 15 years and the acknowledged risks with multiple pregnancies, it may now be more cost‐effective to recommend IVF earlier in the management algorithm.…”

Cost‐effectiveness of tubal patency tests

“…Cycle length was set at 1 month. We used a time frame of 3 years because the chances of natural conception in couples with unexplained subfertility within these 3 years are substantial . The outcome was defined as a live birth of at least one child.…”