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Double versus single homologous intrauterine insemination for male factor infertility： a systematic review and meta-analysis

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Asian Journal of Andrology 2013年第4期15卷 533-538,I0010页

作者： Apostolos Zavos Alexandros Daoonte Antonios Garas Christina Verykouki Evangelos Papanikolao~ georgios anifandis Nikolaos P Polyzos Obstetrics and Gynecology University Hospital of Larissa Larissa 41110 Greece Aristotle University of Thessaloniki Assisted Reproduction Unit 1st OB-GYN Department Thessaloniki 56429 Greece and University Hospital Dutch-Speaking Free University of Brussels Brussels City 1090 Belgium

Male factor infertility affects 30%-50% of infertile couples worldwide, and there is an increasing interest in the optimal management of these patients. In studies comparing double and single intrauterine insemination （IUI）, a trend towards higher pregnancy rates in couples with male factor infertility was observed. Therefore, we set out to perform a meta-analysis to examine the superiority of double versus single IUI with the male partner＇s sperm in couples with male factor infertility. An odds ratio （OR） of 95% confidence intervals （CIs） was calculated for the pregnancy rate. Outcomes were analysed by using the ManteI-Haesel or DerSimonian-Laird model accordingto the heterogeneity of the results. Overall, five trials involving 1125 IUI cycles were included in the meta-analysis. There was a two-fold increase in pregnancies after a cycle with a double IUI compared with a cycle with a single IUI （OR. 2.0; 95% CI. 1.07-3.75; P〈O.03）. Nevertheless, this result was mainly attributed to the presence of a large trial that weighted as almost 50% in the overall analysis. Sensitivity analysis, excluding this large trial, revealed only a trend towards higher pregnancy rates among double IUI cycles （OR. 1.58; 95% CI. 0.59-4.21）, but without statistical significance （P=0.20）. Our systematic review highlights that the available evidence regarding the use of double IUI in couples with male factor infertility is fragmentary and weak. Although there may be a trend towards higher pregnancy rates when the number of IUIs per cycle is increased, further large and well-designed randomized trials are needed to provide solid evidence toide current clinical practice.

关键词： homologous intrauterine insemination male infertility meta-analysis systematic review

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