Intrauterine insemination in Jamaica as a low‐cost subfertility treatment in a low‐resource region

Christie, L; Harriott, J; DaCosta, V; Wynter, S; Everett, D; Foster, R

doi:10.1016/j.ijgo.2010.10.017

Cited by 1 publication

(10 citation statements)

References 16 publications

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“…6 papers evaluating the effects of IUI upon LB rates were identified, with 1 randomised controlled trial (RCT) and 5 retrospective observational studies [ 16 – 21 ]. The reliance on retrospective analysis diminishes the quality of evidence available and further RCTs are advised.…”

Section: Iui and Pregnancy Outcomesmentioning

confidence: 99%

“…Although studies reporting cumulative LB rates have comparable results (26.5% versus 28.5%) [ 18 , 19 ], inconsistencies exist in how rates were calculated with only one [ 19 ] adjusting for confounders, and no comparisons against EM could be made due to their lack of control groups. LB rates varied widely between 8.8% and 38% in the literature, but most were single-centre studies conducted in different countries and thus lack generalisability to clinical practice across the UK [ 18 , 20 , 21 ].…”

Section: Iui and Pregnancy Outcomesmentioning

confidence: 99%

“…Multiple studies have explored the optimum number of IUI-OS cycles leading to a LB. The consensus is that an average 2 cycles of IUI-OS are required [ 18 – 21 ]. Multiparous women aged < 32 years on their first IUI-OS cycle had the best chances of LB with a probability of 21.4% [ 19 , 20 ].…”

Section: Iui and Pregnancy Outcomesmentioning

confidence: 99%

“…Osmanlıoğlu Ş et al report up to 3 cycles are effective, yet only 27% of their cohort had a third cycle with more opting for IVF treatment after a failed second cycle [ 18 ]. Many were limited in sample size, due to high numbers of unexplained dropout rates [ 18 , 19 , 21 ].…”

Section: Iui and Pregnancy Outcomesmentioning

confidence: 99%

“…The NICE guidelines state that OS agents should not be offered to women with unexplained infertility [ 4 ], although IUI-OS has been shown to increase LB [ 16 , 17 , 20 ]. Huang et al and Osmanlıoğlu Ş et al achieved similar LB rates between stimulation methods [ 18 ], however Christie et al found IUI-OS with human menopausal gonadotrophin (HMG) led to nearly 3 times higher LB than IUI-OS with CC [ 21 ]. This study had similar proportions of IUI-HMG cycles and IUI-CC cycles (40.9% versus 45.3%) but was limited by large 95% CI (0.78–8.80), small sample size (n = 72 versus 65 cycles) and selection bias due to its setting in Jamaica where no financial support for fertility treatment is available and CC is less costly than HMG [ 21 ].…”

Section: Iui and Pregnancy Outcomesmentioning

confidence: 99%

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Should IUI replace IVF as first-line treatment for unexplained infertility? A literature review

Man,

Parker,

Broughton

et al. 2023

BMC Women's Health

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Background Unexplained infertility accounts for 25% of infertility causes in the UK. Active intervention methods, such as intrauterine insemination (IUI) or in vitro fertilisation (IVF), are often sought. Despite the National Institute for Health and Care Excellence (NICE) recommending IVF for unexplained infertility, this recommendation has generated an ongoing debate, with few fertility clinics discontinuing the use of IUI as the first-line management of choice. In contrast to NICE, recent guidance released from the European Society for Human Reproduction and Embryology (ESHRE) in August 2023 supports the use of IUI as first-line. High-quality evidence behind such interventions is lacking, with current literature providing conflicting results. Aims This review aims to provide a literature overview exploring whether IUI or IVF should be used as first-line treatment for couples with unexplained infertility, in the context of current guidelines. Methods The primary outcome used to assess efficacy of both treatment methods is live birth (LB) rates. Secondary outcomes used are clinical pregnancy (CP) and ongoing pregnancy (OP) rates. A comprehensive literature search of 4 databases: Ovid MEDLINE, EMBASE, Maternity & Infant Care and the Cochrane Library were searched in January 2022. Upon removal of duplications, abstract screening, and full-text screening, a total of 34 papers were selected. Discussion/conclusion This review highlights a large discrepancy in the literature when examining pregnancy outcomes of IUI and IVF treatments. Evidence shows IUI increases LB and CP rates 3-fold compared to expectant management. Literature comparing IUI to IVF is less certain. The review finds the literature implies IVF should be used for first-line management but the paucity of high-quality randomised controlled trials (RCTs), coupled with heterogeneity of the identified studies and a lack of research amongst women > 40 years warrants the need for further large RCTs. The decision to offer IUI with ovarian stimulation (IUI-OS) or IVF should be based upon patient prognostic factors. We suggest that IUI-OS could be offered as first-line treatment for unexplained infertility for women < 38 years, with good prognosis, and IVF could be offered first to those > 38 years. Patients should be appropriately counselled to enable informed decision making.

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Section: Iui and Pregnancy Outcomesmentioning

confidence: 99%