Single versus double intrauterine insemination (IUI) in stimulated cycles for subfertile couples

Abstract

BACKGROUND: Intra uterine insemination (IUI), with or without controlled ovarian hyperstimulation (COH), is one of the treatment modalities offered to couples who have tried to conceive for at least one year (subfertile couples). It has been suggested that increasing the number of inseminations from one per cycle to two might increase the probability of conception. OBJECTIVES: To determine if there is a difference in live birth or pregnancy rates for subfertile couples using single or double intrauterine insemination in stimulated cycles. SEARCH STRATEGY: We searched the Cochrane Menstrual Disorders and Subfertility group trials register (searched 8 July 2002), the Cochrane Controlled Trials Register (Cochrane Library Issue 1, 2002), MEDLINE (January 1966 to July 2002), EMBASE (January 1988 to July 2002), SCIENCE Direct Database (January 1966 to July 2002), Confsci (January 1973 to 15 July 2002), Pascal (January 1984 to July 2002) and reference lists of articles. We also contacted researchers in the field. SELECTION CRITERIA: Randomised controlled, parallel trials of single versus double intrauterine inseminations in simulated cycles in subfertile couples. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed trial quality and extracted data. Study authors were contacted for additional information. MAIN RESULTS: Three studies involving 386 women were included. There was no data for the main outcome measure of live birth per couple or ongoing pregnancy rates, and none presented comparative data for adverse events. The results of two studies that reported pregnancy rate per couple did not show a significant effect of using double insemination (Peto OR 1.45, 95% CI 0.78-2.70). REVIEWER'S CONCLUSIONS: Based on the results of pregnancy rate per couple of two trials, double intrauterine insemination showed no significant benefit over single intrauterine insemination in the treatment of subfertile couples with husband semen. There are no meaningful data to offer advice regarding clinical practice on the basis of this review.