Document Detail


Intra-uterine versus cervical insemination of donor sperm for subfertility.
MedLine Citation:
PMID:  10796709     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Artificial insemination with sperm is used to improve the chances of conception for various causes of infertility. Traditionally, sperm is deposited in or around the endocervical canal (cervical insemination - CI). Some studies reported higher pregnancy rates if sperm was deposited in the uterine cavity itself (intrauterine insemination - IUI), but most were uncontrolled. However the cost and the risks (infection and anaphylaxis) of IUI may also be higher.
OBJECTIVES: The objective of this review was to assess the effects of depositing donor sperm in the uterine cavity (intrauterine insemination) compared to cervical insemination.
SEARCH STRATEGY: The Cochrane Subfertility Review Group specialised register of controlled trials was searched.
SELECTION CRITERIA: Randomised trials comparing intrauterine insemination and cervical insemination, using fresh or cryopreserved semen, with or without ovarian hyperstimulation.
DATA COLLECTION AND ANALYSIS: Trial quality assessment and data extraction were done independently by two reviewers.
MAIN RESULTS: Twelve studies were included. They comprised 697 patients undergoing 2215 treatment cycles. Ten trials used frozen semen, with three using ovarian hyperstimulation. Overall the methodological quality of the trials was low. The overall pregnancy rate per cycle in the intrauterine insemination group was 18% compared to 5% for cervical insemination. When cryopreserved donor sperm was used, the overall chance of pregnancy in spontaneous or clomiphene-corrected cycles was significantly higher with intrauterine insemination. This was irrespective of whether pregnancy rates were calculated on a per cycle (odds ratio 2. 63, 95% confidence interval 1.85 to 3.73) or per patient (odds ratio 3.86, 95% confidence interval 1.81 to 8.25) basis. The greatest benefit appeared in trials with poor pregnancy rates (less than 6%) for cervical insemination. There was no difference in pregnancy rate between intrauterine and cervical insemination when fresh donor sperm was used (odds ratio 0.90, 95% confidence interval 0.36 to 2. 24).
REVIEWER'S CONCLUSIONS: Intrauterine insemination appears to be beneficial when cervical insemination using cryopreserved donor sperm has had low pregnancy rates. This applies to spontaneous, clomiphene corrected and gonadotrophin stimulated cycles. However it may offer little benefit where high pregnancy rates have been achieved with cervical insemination. There appears to be no additional benefit from intrauterine insemination when fresh sperm is used for donor insemination.
Authors:
P O'Brien; P Vandekerckhove
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  The Cochrane database of systematic reviews     Volume:  -     ISSN:  1469-493X     ISO Abbreviation:  Cochrane Database Syst Rev     Publication Date:  2000  
Date Detail:
Created Date:  2000-07-06     Completed Date:  2000-07-06     Revised Date:  2013-06-28    
Medline Journal Info:
Nlm Unique ID:  100909747     Medline TA:  Cochrane Database Syst Rev     Country:  ENGLAND    
Other Details:
Languages:  eng     Pagination:  CD000317     Citation Subset:  IM    
Affiliation:
Parkside Health NHS Trust, 19 Calthorpe Street, London, UK, UK, WC1X 0JP. PaulOBrien@care.prestel.co.uk
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MeSH Terms
Descriptor/Qualifier:
Cervix Uteri
Female
Humans
Insemination, Artificial / methods*
Pregnancy
Pregnancy Rate
Uterus
Comments/Corrections
Update In:
Cochrane Database Syst Rev. 1998;(4):CD000317   [PMID:  17636628 ]
Cochrane Database Syst Rev. 2008;(2):CD000317   [PMID:  18425862 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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