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The Cochrane Database of Systematic... Oct 2005The postcoital test has poor diagnostic and prognostic characteristics. Nevertheless, some physicians believe it can identify scanty or abnormal mucus that might impair... (Review)
Review
BACKGROUND
The postcoital test has poor diagnostic and prognostic characteristics. Nevertheless, some physicians believe it can identify scanty or abnormal mucus that might impair fertility. One way to avoid 'hostile' cervical mucus is intrauterine insemination. With this technique, the physician injects sperm directly into the uterine cavity through a small catheter passed through the cervix; the theory is to bypass the "hostile" cervical mucus. Although most gynaecological societies do not endorse use of intrauterine insemination for hostile cervical mucus, some physicians consider it an effective treatment for women with infertility thought due to cervical mucus problems.
OBJECTIVES
The aim of this review was to determine the effectiveness of intrauterine insemination with or without ovarian stimulation in women with cervical hostility who failed to conceive.
SEARCH STRATEGY
We searched Cochrane Central Register of Controlled Trials (CENTRAL) on The Cochrane Library Issue 2, 2005, MEDLINE (1966 to June 2005), EMBASE (1980 to June 2005), POPLINE (to June 2005) and LILACS (to June 2005). In addition, we contacted experts and searched the reference list of relevant articles and book chapters.
SELECTION CRITERIA
We included randomized and quasi-randomized controlled trials comparing intrauterine insemination with intercourse timed at the presumed fertile period. Participants were women with cervical hostility who failed to conceive for at least one year.
DATA COLLECTION AND ANALYSIS
We assessed the titles and abstracts of 386 publications and two reviewers independently abstracted data on methods and results from five studies identified for inclusion. The main outcome is pregnancy rate per couple.
MAIN RESULTS
We did not pool the outcomes of the included five studies in a meta-analysis due to the methodological quality of the trials and variations in the patient characteristics and interventions. Narrative summaries of the outcomes are provided. Each study was too small for a clinically relevant conclusion. None of the studies provided information on important outcomes such as spontaneous abortion, multiple pregnancies, and ovarian hyperstimulation syndrome.
AUTHORS' CONCLUSIONS
There is no evidence from the published studies that intrauterine insemination is an effective treatment for cervical hostility. Given the poor diagnostic and prognostic properties of the postcoital test and the observation that the test has no benefit on pregnancy rates, intrauterine insemination (with or without ovarian stimulation) is unlikely to be a useful treatment for putative problems identified by postcoital testing.
Topics: Biomarkers; Cervix Mucus; Coitus; Female; Humans; Infertility; Insemination, Artificial, Homologous; Luteinizing Hormone; Time Factors
PubMed: 16235303
DOI: 10.1002/14651858.CD002809.pub2 -
The Cochrane Database of Systematic... Dec 2014In many countries intrauterine insemination (IUI) is the treatment of first choice for a subfertile couple when the infertility work up reveals an ovulatory cycle, at... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
In many countries intrauterine insemination (IUI) is the treatment of first choice for a subfertile couple when the infertility work up reveals an ovulatory cycle, at least one open Fallopian tube and sufficient spermatozoa. The final goal of this treatment is to achieve a pregnancy and deliver a healthy (singleton) live birth. The probability of conceiving with IUI depends on various factors including age of the couple, type of subfertility, ovarian stimulation and the timing of insemination. IUI should logically be performed around the moment of ovulation. Since spermatozoa and oocytes have only limited survival time correct timing of the insemination is essential. As it is not known which technique of timing for IUI results in the best treatment outcome, we compared different techniques for timing IUI and different time intervals.
OBJECTIVES
To evaluate the effectiveness of different synchronisation methods in natural and stimulated cycles for IUI in subfertile couples.
SEARCH METHODS
We searched for all publications which described randomised controlled trials of the timing of IUI. We searched the Cochrane Menstrual Disorders and Subfertility Group Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL) (1966 to October 2014), EMBASE (1974 to October 2014), MEDLINE (1966 to October 2014) and PsycINFO (inception to October 2014) electronic databases and prospective trial registers. Furthermore, we checked the reference lists of all obtained studies and performed a handsearch of conference abstracts.
SELECTION CRITERIA
Randomised controlled trials (RCTs) comparing different timing methods for IUI were included. The following interventions were evaluated: detection of luteinising hormone (LH) in urine or blood, single test; human chorionic gonadotropin (hCG) administration; combination of LH detection and hCG administration; basal body temperature chart; ultrasound detection of ovulation; gonadotropin-releasing hormone (GnRH) agonist administration; or other timing methods.
DATA COLLECTION AND ANALYSIS
Two review authors independently selected the trials, extracted the data and assessed study risk of bias. We performed statistical analyses in accordance with the guidelines for statistical analysis developed by The Cochrane Collaboration. The overall quality of the evidence was assessed using GRADE methods.
MAIN RESULTS
Eighteen RCTs were included in the review, of which 14 were included in the meta-analyses (in total 2279 couples). The evidence was current to October 2013. The quality of the evidence was low or very low for most comparisons . The main limitations in the evidence were failure to describe study methods, serious imprecision and attrition bias.Ten RCTs compared different methods of timing for IUI. We found no evidence of a difference in live birth rates between hCG injection versus LH surge (odds ratio (OR) 1.0, 95% confidence interval (CI) 0.06 to 18, 1 RCT, 24 women, very low quality evidence), urinary hCG versus recombinant hCG (OR 1.17, 95% CI 0.68 to 2.03, 1 RCT, 284 women, low quality evidence) or hCG versus GnRH agonist (OR 1.04, 95% CI 0.42 to 2.6, 3 RCTS, 104 women, I(2) = 0%, low quality evidence).Two RCTs compared the optimum time interval from hCG injection to IUI, comparing different time frames that ranged from 24 hours to 48 hours. Only one of these studies reported live birth rates, and found no difference between the groups (OR 0.52, 95% CI 0.27 to 1.00, 1 RCT, 204 couples). One study compared early versus late hCG administration and one study compared different dosages of hCG, but neither reported the primary outcome of live birth.We found no evidence of a difference between any of the groups in rates of pregnancy or adverse events (multiple pregnancy, miscarriage, ovarian hyperstimulation syndrome (OHSS)). However, most of these data were very low quality.
AUTHORS' CONCLUSIONS
There is insufficient evidence to determine whether there is any difference in safety and effectiveness between different methods of synchronization of ovulation and insemination. More research is needed.
Topics: Adult; Body Temperature; Chorionic Gonadotropin; Female; Gonadotropin-Releasing Hormone; Humans; Infertility; Insemination, Artificial; Luteinizing Hormone; Male; Ovulation Detection; Randomized Controlled Trials as Topic; Time Factors; Young Adult
PubMed: 25528596
DOI: 10.1002/14651858.CD006942.pub3 -
Fertility and Sterility Mar 2016To evaluate the effectiveness of semen washing in human immunodeficiency virus (HIV)-discordant couples in which the male partner is infected. (Meta-Analysis)
Meta-Analysis Review
Effectiveness of semen washing to prevent human immunodeficiency virus (HIV) transmission and assist pregnancy in HIV-discordant couples: a systematic review and meta-analysis.
OBJECTIVE
To evaluate the effectiveness of semen washing in human immunodeficiency virus (HIV)-discordant couples in which the male partner is infected.
DESIGN
Systematic review and meta-analysis.
SETTING
Not applicable.
PATIENT(S)
Forty single-arm open-label studies among HIV-discordant couples that underwent intrauterine insemination (IUI) or in vitro fertilization (IVF) with or without intracytoplasmic sperm injection (ICSI) using washed semen.
INTERVENTION(S)
Semen washing followed by IUI, IVF, or IVF/ICSI.
PRIMARY OUTCOME
HIV transmission to HIV-uninfected women; secondary outcomes: HIV transmission to newborns and proportion of couples achieving a clinical pregnancy.
RESULT(S)
No HIV transmission occurred in 11,585 cycles of assisted reproduction with the use of washed semen among 3,994 women. Among the subset of HIV-infected men without plasma viral suppression at the time of semen washing, no HIV seroconversions occurred among 1,023 women after 2,863 cycles of assisted reproduction with the use of washed semen. Studies that measured HIV transmission to infants reported no cases of vertical transmission. Overall, 56.3% of couples (2,357/4,184) achieved a clinical pregnancy with the use of washed semen.
CONCLUSION(S)
Semen washing appears to significantly reduce the risk of transmission in HIV-discordant couples desiring children, regardless of viral suppression in the male partner. There are no randomized controlled studies or studies from low-income countries, especially those with a large burden of HIV. Continued development of lower-cost semen washing and assisted reproduction technologies is needed. Integration of semen washing into HIV prevention interventions could help to further reduce the spread of HIV.
Topics: Adult; Female; Fertilization in Vitro; HIV; HIV Infections; HIV Seronegativity; HIV Seropositivity; Humans; Infectious Disease Transmission, Vertical; Insemination, Artificial; Male; Middle Aged; Pregnancy; Pregnancy Rate; Risk Factors; Sperm Injections, Intracytoplasmic; Sperm Retrieval; Spermatozoa; Treatment Outcome
PubMed: 26688556
DOI: 10.1016/j.fertnstert.2015.11.028 -
Revista de Salud Publica (Bogota,... 2014To determine the factors associated with the presence of cytoplasmic droplets in boars. (Review)
Review
OBJECTIVE
To determine the factors associated with the presence of cytoplasmic droplets in boars.
METHODS
A systematic review was carried out in which 133 articles were found, 70 were eliminated due to duplication, and 65 were finally selected: 57 in Cab Abstract, 39 in Pub Med, 20 in Agricola, and 17 in Science Direct. Forty-seven articles were found with an available full text. Data was tabulated in EpiData Entry and transferred to the Stata version 12.0 program.
RESULTS
Factors Associated with cytoplasmic droplets are: Climatic and environmental variables; ejaculation frequency with intervals of less than three weeks; spermatic morphologic alterations in tail (coiled and distal reflex); DNA fragmentation; and enzymatic factors related to seminal biochemistry. Work carried out in equatorial climate regions or that focused on the analysis of the implications of CDs in artificial insemination centers was not found.
CONCLUSIONS
The information is characterized by a wide heterogeneity and diversity studies. A contribution was made to Veterinary Public Health in Colombia on the importance of CGs as factors that limit reproductive processes in swine. It was not possible to determine the temporal relationship between the cause and effect of CDs.
Topics: Animals; Climate; DNA Fragmentation; Ejaculation; Inclusion Bodies; Insemination, Artificial; Male; Semen Analysis; Spermatozoa; Sus scrofa
PubMed: 26120862
DOI: No ID Found -
Medicine Jul 2020With the medical advancement some studies put forward that letrozole (LE), a specific aromatase inhibitor with the function of reducing oestrogen synthesis, has recently... (Comparative Study)
Comparative Study Meta-Analysis
Comparison of clomiphene and letrozole for superovulation in patients with unexplained infertility undergoing intrauterine insemination: A systematic review and meta-analysis.
BACKGROUND
With the medical advancement some studies put forward that letrozole (LE), a specific aromatase inhibitor with the function of reducing oestrogen synthesis, has recently been applied as a potentially better alternative compared with clomiphene citrate (CC), owing to that it has a superior efficacy as compared with CC in patients of unexplained infertility undergoing intrauterine insemination (IUI). However, there is no one study can clear and definite whether LE can replace the CC as first line drug.
OBJECTIVE
Our objective is to compare the LE with CC in the induction of ovulation in patients with unexplained infertility IUI.
METHOD
Searching databases consist of all kinds of searching tools, such as Medline, The Cochrane Library, Embase, PubMed, etc. All the include studies should meet our demand of this meta-analysis: RESULT:: Based on the current meta-analysis, we rigorously consider that LE has a likelihood to improve dominant follicles (MD= -0.56, I= 100%, P= .04; MD= -0.39, I= 73%, P = .0003, respectively) and reduces the miscarriage rate (RR= 0.61, I= 0%, P = .03). There is no significant differences between the 2 groups in The total rate of pregnancy, pregnancy rate per cycle, multiple pregnancy and endometrial thickness. (RR= 1.06, I= 11%, P = .38; RR= 1.09, I= 7%, P = .32; RR= 0.79, I= 0%, P = .46; respectively) CONCLUSION:: Combined with the results of current systematic review and meta-analysis through subgroup analysis and sensitivity analysis, we can be cautious: in general, compared with CC, LE is an effective treatment in the IUI cycle, has a likelihood to improve dominant follicles and reduces the miscarriage rate.
Topics: Clomiphene; Female; Fertility Agents, Female; Humans; Infertility, Female; Insemination, Artificial; Letrozole; Superovulation
PubMed: 32756085
DOI: 10.1097/MD.0000000000021006 -
Frontiers in Veterinary Science 2024South Africa is home to numerous indigenous and locally developed sheep (Nguni Pedi, Zulu, and Namaqua Afrikaner, Afrino, Africander, Bezuidenhout Africander, Damara,...
South Africa is home to numerous indigenous and locally developed sheep (Nguni Pedi, Zulu, and Namaqua Afrikaner, Afrino, Africander, Bezuidenhout Africander, Damara, Dorper, Döhne Merino, Meat Master, South African Merino, South African Mutton Merino, Van Rooy, and Dorper), goat (SA veld, Tankwa, Imbuzi, Bantu, Boer, and Savanna) and cattle (Afrigus, Afrikaner, Bolowana, Bonsmara, Bovelder, Drakensberger, South African Angus, South African Dairy Swiss, South African Friesland, South African Red, and Veld Master) animals. These breeds require less veterinary service, feed, management efforts, provide income to rural and or poor owners. However, most of them are under extinction risks and some with unknown status hence, require immediate conservation intervention. To allow faster genetic progress on the endangered animals, it is important to generate productive animals while reducing wastages and this can be achieved through sex-sorted semen. Therefore, this systematic review is aimed to evaluate the prospects of X and Y-sexed semen in ruminant livestock and some solutions that can be used to address poor sex-sorted semen and its fertility. This review was incorporated through gathering and assessing relevant articles and through the data from the DAD-IS database. The keywords that were used to search articles online were pre-gender selection, indigenous ecotypes, fertility, flow cytometry, artificial insemination, conservation, and improving sexed semen. Following a careful review of all articles, PRISMA guidelines were used to find the articles that are suitable to address the aim of this review. Sex-sorted semen is a recently introduced technology gaining more attention from researchers particularly, in the conservation programs. Preselection of semen based on the sex chromosomes (X- and or Y-bearing chromosomes) is of paramount importance to obtain desired sex of the offspring and avoid animal wastage as much as possible. However, diverse factors can affect quality of semen of different animal species especially after sex-sorting. Flow cytometry is a common method used to select male and female sperm cells and discard dead and abnormal sperm cells during the process. Thus, sperm sexing is a good advanced reproductive technology (ART) however, it is associated with the production of oxidative stress (OS) and DNA fragmentation (SDF). These findings, therefore, necessitates more innovation studies to come up with a sexing technology that will protect sperm cell injuries during sorting in frozen-thawed.
PubMed: 38655533
DOI: 10.3389/fvets.2024.1384768 -
The Cochrane Database of Systematic... Mar 2020Intra-uterine insemination (IUI) is a widely-used fertility treatment for couples with unexplained subfertility. Although IUI is less invasive and less expensive than in... (Meta-Analysis)
Meta-Analysis
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, the live birth rate is improved following IUI treatment with or without OH compared to timed intercourse (TI) or expectant management with or without OH, or following IUI treatment with OH compared to IUI in a natural cycle.
SEARCH METHODS
We searched the Cochrane Gynaecology and Fertility (CGF) Group trials register, CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL and two trials registers up to 17 October 2019, together with reference checking and contact with study authors for missing or unpublished data.
SELECTION CRITERIA
Randomised controlled trials (RCTs) comparing IUI with TI or expectant management, both in stimulated or natural cycles, or IUI in stimulated cycles with IUI in natural cycles in couples with unexplained subfertility.
DATA COLLECTION AND ANALYSIS
Two review authors independently performed study selection, quality assessment and data extraction. Primary review outcomes were live birth rate and multiple pregnancy rate.
MAIN RESULTS
We include 15 trials with 2068 women. The evidence was of very low to moderate quality. The main limitation was very serious imprecision. IUI in a natural cycle versus timed intercourse or expectant management in a natural cycle It is uncertain whether treatment with IUI in a natural cycle improves live birth rate compared to treatment with expectant management in a natural cycle (odds ratio (OR) 1.60, 95% confidence interval (CI) 0.92 to 2.78; 1 RCT, 334 women; low-quality evidence). If we assume the chance of a live birth with expectant management in a natural cycle to be 16%, that of IUI in a natural cycle would be between 15% and 34%. It is uncertain whether treatment with IUI in a natural cycle reduces multiple pregnancy rates compared to control (OR 0.50, 95% CI 0.04 to 5.53; 1 RCT, 334 women; low-quality evidence). IUI in a stimulated cycle versus timed intercourse or expectant management in a stimulated cycle It is uncertain whether treatment with IUI in a stimulated cycle improves live birth rates compared to treatment with TI in a stimulated cycle (OR 1.59, 95% CI 0.88 to 2.88; 2 RCTs, 208 women; I = 72%; low-quality evidence). If we assume the chance of achieving a live birth with TI in a stimulated cycle was 26%, the chance with IUI in a stimulated cycle would be between 23% and 50%. It is uncertain whether treatment with IUI in a stimulated cycle reduces multiple pregnancy rates compared to control (OR 1.46, 95% CI 0.55 to 3.87; 4 RCTs, 316 women; I = 0%; low-quality evidence). IUI in a stimulated cycle versus timed intercourse or expectant management in a natural cycle In couples with a low prediction score of natural conception, treatment with IUI combined with clomiphene citrate or letrozole probably results in a higher live birth rate compared to treatment with expectant management in a natural cycle (OR 4.48, 95% CI 2.00 to 10.01; 1 RCT; 201 women; moderate-quality evidence). If we assume the chance of a live birth with expectant management in a natural cycle was 9%, the chance of a live birth with IUI in a stimulated cycle would be between 17% and 50%. It is uncertain whether treatment with IUI in a stimulated cycle results in a lower multiple pregnancy rate compared to control (OR 3.01, 95% CI 0.47 to 19.28; 2 RCTs, 454 women; I = 0%; low-quality evidence). IUI in a natural cycle versus timed intercourse or expectant management in a stimulated cycle Treatment with IUI in a natural cycle probably results in a higher cumulative live birth rate compared to treatment with expectant management in a stimulated cycle (OR 1.95, 95% CI 1.10 to 3.44; 1 RCT, 342 women: moderate-quality evidence). If we assume the chance of a live birth with expectant management in a stimulated cycle was 13%, the chance of a live birth with IUI in a natural cycle would be between 14% and 34%. It is uncertain whether treatment with IUI in a natural cycle results in a lower multiple pregnancy rate compared to control (OR 1.05, 95% CI 0.07 to 16.90; 1 RCT, 342 women; low-quality evidence). IUI in a stimulated cycle versus IUI in a natural cycle Treatment with IUI in a stimulated cycle may result in a higher cumulative live birth rate compared to treatment with IUI in a natural cycle (OR 2.07, 95% CI 1.22 to 3.50; 4 RCTs, 396 women; I = 0%; low-quality evidence). If we assume the chance of a live birth with IUI in a natural cycle was 14%, the chance of a live birth with IUI in a stimulated cycle would be between 17% and 36%. It is uncertain whether treatment with IUI in a stimulated cycle results in a higher multiple pregnancy rate compared to control (OR 3.00, 95% CI 0.11 to 78.27; 2 RCTs, 65 women; low-quality evidence).
AUTHORS' CONCLUSIONS
Due to insufficient data, it is uncertain whether treatment with IUI with or without OH compared to timed intercourse or expectant management with or without OH improves cumulative live birth rates with acceptable multiple pregnancy rates in couples with unexplained subfertility. However, treatment with IUI with OH probably results in a higher cumulative live birth rate compared to expectant management without OH in couples with a low prediction score of natural conception. Similarly, treatment with IUI in a natural cycle probably results in a higher cumulative live birth rate compared to treatment with timed intercourse with OH. Treatment with IUI in a stimulated cycle may result in a higher cumulative live birth rate compared to treatment with IUI in a natural cycle.
Topics: Abortion, Spontaneous; Coitus; Female; Fertile Period; Fertility Agents, Female; Humans; Infertility; Insemination, Artificial; Live Birth; Male; Ovarian Hyperstimulation Syndrome; Ovulation Induction; Pregnancy; Pregnancy Rate; Pregnancy, Multiple; Randomized Controlled Trials as Topic; Time Factors; Watchful Waiting
PubMed: 32124980
DOI: 10.1002/14651858.CD001838.pub6 -
Hysteroscopy for treating subfertility associated with suspected major uterine cavity abnormalities.The Cochrane Database of Systematic... Feb 2015Observational studies suggest higher pregnancy rates after the hysteroscopic removal of endometrial polyps, submucous fibroids, uterine septum or intrauterine adhesions,... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Observational studies suggest higher pregnancy rates after the hysteroscopic removal of endometrial polyps, submucous fibroids, uterine septum or intrauterine adhesions, which are detectable in 10% to 15% of women seeking treatment for subfertility.
OBJECTIVES
To assess the effects of the hysteroscopic removal of endometrial polyps, submucous fibroids, uterine septum or intrauterine adhesions suspected on ultrasound, hysterosalpingography, diagnostic hysteroscopy or any combination of these methods in women with otherwise unexplained subfertility or prior to intrauterine insemination (IUI), in vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI).
SEARCH METHODS
We searched the Cochrane Menstrual Disorders and Subfertility Specialised Register (8 September 2014), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2014, Issue 9), MEDLINE (1950 to 12 October 2014), EMBASE (inception to 12 October 2014), CINAHL (inception to 11 October 2014) and other electronic sources of trials including trial registers, sources of unpublished literature and reference lists. We handsearched the American Society for Reproductive Medicine (ASRM) conference abstracts and proceedings (from January 2013 to October 2014) and we contacted experts in the field.
SELECTION CRITERIA
Randomised comparisons between operative hysteroscopy versus control in women with otherwise unexplained subfertility or undergoing IUI, IVF or ICSI and suspected major uterine cavity abnormalities diagnosed by ultrasonography, saline infusion/gel instillation sonography, hysterosalpingography, diagnostic hysteroscopy or any combination of these methods. Primary outcomes were live birth and hysteroscopy complications. Secondary outcomes were pregnancy and miscarriage.
DATA COLLECTION AND ANALYSIS
Two review authors independently assessed studies for inclusion and risk of bias, and extracted data. We contacted study authors for additional information.
MAIN RESULTS
We retrieved 12 randomised trials possibly addressing the research questions. Only two studies (309 women) met the inclusion criteria. Neither reported the primary outcomes of live birth or procedure related complications. In women with otherwise unexplained subfertility and submucous fibroids there was no conclusive evidence of a difference between the intervention group treated with hysteroscopic myomectomy and the control group having regular fertility-oriented intercourse during 12 months for the outcome of clinical pregnancy. A large clinical benefit with hysteroscopic myomectomy cannot be excluded: if 21% of women with fibroids achieve a clinical pregnancy having timed intercourse only, the evidence suggests that 39% of women (95% CI 21% to 58%) will achieve a successful outcome following the hysteroscopic removal of the fibroids (odds ratio (OR) 2.44, 95% confidence interval (CI) 0.97 to 6.17, P = 0.06, 94 women, very low quality evidence). There is no evidence of a difference between the comparison groups for the outcome of miscarriage (OR 0.58, 95% CI 0.12 to 2.85, P = 0.50, 30 clinical pregnancies in 94 women, very low quality evidence). The hysteroscopic removal of polyps prior to IUI can increase the chance of a clinical pregnancy compared to simple diagnostic hysteroscopy and polyp biopsy: if 28% of women achieve a clinical pregnancy with a simple diagnostic hysteroscopy, the evidence suggests that 63% of women (95% CI 50% to 76%) will achieve a clinical pregnancy after the hysteroscopic removal of the endometrial polyps (OR 4.41, 95% CI 2.45 to 7.96, P < 0.00001, 204 women, moderate quality evidence).
AUTHORS' CONCLUSIONS
A large benefit with the hysteroscopic removal of submucous fibroids for improving the chance of clinical pregnancy in women with otherwise unexplained subfertility cannot be excluded. The hysteroscopic removal of endometrial polyps suspected on ultrasound in women prior to IUI may increase the clinical pregnancy rate. More randomised studies are needed to substantiate the effectiveness of the hysteroscopic removal of suspected endometrial polyps, submucous fibroids, uterine septum or intrauterine adhesions in women with unexplained subfertility or prior to IUI, IVF or ICSI.
Topics: Coitus; Endometrium; Female; Fertilization in Vitro; Humans; Hysteroscopy; Infertility; Insemination, Artificial; Leiomyoma; Polyps; Pregnancy; Randomized Controlled Trials as Topic; Tissue Adhesions; Uterine Diseases; Uterus
PubMed: 25701429
DOI: 10.1002/14651858.CD009461.pub3 -
PloS One 2014Recent studies have indicated the use of gonadotropin-releasing hormone antagonists (GnRH-ant) as an adjuvant treatment to prevent premature luteinization (PL) and... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Recent studies have indicated the use of gonadotropin-releasing hormone antagonists (GnRH-ant) as an adjuvant treatment to prevent premature luteinization (PL) and improve the clinical outcomes in patients undergoing controlled ovarian stimulation (COS) with intrauterine insemination (IUI). However, the results of these studies are conflicting.
METHODS
We conducted a systematic review and meta-analysis of randomized trials aiming to compare the clinical efficacy of GnRH-ant in COS/IUI cycles. Twelve studies were identified that met inclusion criteria and comprised 2,577 cycles assigned to COS/IUI combined GnRH-ant or COS/IUI alone.
RESULTS
Meta-analysis results suggested that GnRH-ant can significantly increase the clinical pregnancy rate (CPR) (OR = 1.42; 95% CI, 1.13-1.78) and decrease the PL rate (OR = 0.22, 95% CI, 0.16-0.30) in COS/IUI cycles. Subgroup analysis results suggested statistically significant improvement in the CPR in non-PCOS patients (OR = 1.54; 95% CI, 1.03-2.31) but not in the PCOS population (OR = 1.65; 95% CI, 0.93-2.94) and multiple mature follicle cycles (OR = 1.87; 95% CI, 0.27-12.66). There were no difference in the miscarriage and multiple pregnancy rates between the groups.
CONCLUSION
This meta-analysis suggested that GnRH-ant can reduce the incidence of PL and increase the CPR when used in COS/IUI cycles, and it was especially useful for non-PCOS patients. However, evidence to support its use in PCOS patients is still insufficient.
Topics: Adolescent; Adult; Female; Fertilization in Vitro; Gonadotropin-Releasing Hormone; Gonadotropins; Hormone Antagonists; Humans; Infertility; Insemination, Artificial; Luteinization; Male; Ovulation Induction; Pregnancy; Pregnancy Rate; Young Adult
PubMed: 25299186
DOI: 10.1371/journal.pone.0109133 -
Fertility and Sterility Mar 2009To systematically review the literature to identify randomized controlled trials, which evaluate interventions aiming to improve the probability of pregnancy in poor... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To systematically review the literature to identify randomized controlled trials, which evaluate interventions aiming to improve the probability of pregnancy in poor responders undergoing in vitro fertilization (IVF).
DESIGN
Systematic review and meta-analysis.
SETTING
University-based hospital.
INTERVENTION(S)
None.
MAIN OUTCOME MEASURE(S)
Pregnancy rate.
RESULT(S)
Twenty-two eligible randomized controlled trials were identified that evaluated in total 15 interventions to increase pregnancy rates in poor responders. Based on limited evidence, the only interventions that appear to increase the probability of pregnancy were the addition of GH to ovarian stimulation (odds ratio for live birth: 5.22, confidence interval: 95% 1.09-24.99) and the performance of embryo transfer on day 2 compared with day 3 (ongoing pregnancy rate: 27.7% vs. 16.3%, respectively; difference: +11.4, 95% confidence interval: +1.6 to +21.0).
CONCLUSION(S)
Insufficient evidence exists to recommend most of the treatments proposed to improve pregnancy rates in poor responders. Currently, there is some evidence to suggest that addition of GH, as well as performing embryo transfer on day 2 versus day 3, appear to improve the probability of pregnancy.
Topics: Administration, Cutaneous; Administration, Oral; Drug Administration Schedule; Drug Therapy, Combination; Embryo Culture Techniques; Embryo Transfer; Evidence-Based Medicine; Female; Fertility Agents, Female; Fertilization in Vitro; Growth Hormone; Humans; Insemination, Artificial; Odds Ratio; Oocyte Retrieval; Ovulation Induction; Pregnancy; Pregnancy Rate; Probability; Sperm Injections, Intracytoplasmic; Time Factors; Treatment Outcome
PubMed: 18639875
DOI: 10.1016/j.fertnstert.2007.12.077