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| Content Provider | Springer Nature : BioMed Central |
|---|---|
| Author | Man, Jessica Ka-Yan Parker, Anne Elizabeth Broughton, Sophie Ikhlaq, Hamza Das, Mausumi |
| Abstract | 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. |
| Related Links | https://bmcwomenshealth.biomedcentral.com/counter/pdf/10.1186/s12905-023-02717-1.pdf |
| Ending Page | 9 |
| Page Count | 9 |
| Starting Page | 1 |
| File Format | HTM / HTML |
| ISSN | 14726874 |
| DOI | 10.1186/s12905-023-02717-1 |
| Journal | BMC Women's Health |
| Issue Number | 1 |
| Volume Number | 23 |
| Language | English |
| Publisher | BioMed Central |
| Publisher Date | 2023-10-27 |
| Access Restriction | Open |
| Subject Keyword | Gynecology Maternal and Child Health Reproductive Medicine IUI IVF Infertility Unexplained infertility Ovarian stimulation Pregnancy outcomes |
| Content Type | Text |
| Resource Type | Article |
| Subject | Obstetrics and Gynecology Reproductive Medicine |
| Journal Impact Factor | 2.4/2023 |
| 5-Year Journal Impact Factor | 2.9/2023 |
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