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

• Published in: Asian journal of andrology Vol. 15; no. 4; pp. 533 - 538
• Main Authors: Zavos, Apostolos, Daponte, Alexandros, Garas, Antonios, Verykouki, Christina, Papanikolaou, Evangelos, Anifandis, Georgios, Polyzos, Nikolaos P
• Format: Journal Article
• Language: English
• Published: China Medknow Publications & Media Pvt. Ltd 01-07-2013; Nature Publishing Group
• Subjects: Clinical Trials as Topic; Female; Humans; Infertility, Male - therapy; Insemination, Artificial - methods; Male; Original; Pregnancy; Pregnancy Rate; 不孕; 人工授精; 同源; 怀孕率; 男性; 系统; 腔内; 随机试验
• ISSN: 1008-682X; 1745-7262
• DOI: 10.1038/aja.2013.4

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.