Should intrauterine inseminations still be proposed in cases of unexplained infertility? Retrospective study and literature review

Merviel, Philippe; Labarre, Marion; James, Pandora; Bouée, Sarah; Chabaud, Jean-Jacques; Roche, Sylvie; Cabry, Rosalie; Scheffler, Florence; Lourdel, E.; Benkhalifa, Moncef; Copin, Henri; Drapier, Hortense; Beauvillard, Damien

doi:10.1007/s00404-021-06351-w

Cited by 8 publications

(10 citation statements)

References 52 publications

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“…Of the remaining 375 papers, 117 did not classify a definition of unexplained infertility. As a result, a total of 258 primary research papers with full text available were included …”

Section: Resultsmentioning

confidence: 99%

The definition of unexplained infertility: A systematic review

Raperport,

Desai,

Qureshi

et al. 2023

BJOG

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BackgroundThere is no consensus on tests required to either diagnose unexplained infertility or use for research inclusion criteria. This leads to heterogeneity and bias affecting meta‐analysis and best practice advice.ObjectivesThis systematic review analyses the variability of inclusion criteria applied to couples with unexplained infertility. We propose standardised criteria for use both in future research studies and clinical diagnosis.Search strategyCINAHL and MEDLINE online databases were searched up to November 2022 for all published studies recruiting couples with unexplained infertility, available in full text in the English language.Data collection and analysisData were collected in an Excel spreadsheet. Results were analysed per category and methodology or reference range.Main resultsOf 375 relevant studies, only 258 defined their inclusion criteria. The most commonly applied inclusion criteria were semen analysis, tubal patency and assessment of ovulation in 220 (85%), 232 (90%), 205 (79.5%) respectively. Only 87/220 (39.5%) studies reporting semen analysis used the World Health Organization (WHO) limits. Tubal patency was accepted if bilateral in 145/232 (62.5%) and if unilateral in 24/232 (10.3%). Ovulation was assessed using mid‐luteal serum progesterone in 115/205 (56.1%) and by a history of regular cycles in 87/205 (42.4%). Other criteria, including uterine cavity assessment and hormone profile, were applied in less than 50% of included studies.ConclusionsThis review highlights the heterogeneity among studied populations with unexplained infertility. Development and application of internationally accepted criteria will improve the quality of research and future clinical care.

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“…Of the remaining 375 papers, 117 did not classify a definition of unexplained infertility. As a result, a total of 258 primary research papers with full text available were included …”

Section: Resultsmentioning

confidence: 99%

The definition of unexplained infertility: A systematic review

Raperport,

Desai,

Qureshi

et al. 2023

BJOG

View full text Add to dashboard Cite

show abstract

“…A positive β-hCG blood test 14 days after ET was used to diagnose pregnancy ( 18 ). A clinical pregnancy (CP) was defined as the detection of 1 or more gestational sacs via ultrasound ( 19 ).…”

Section: Methodsmentioning

confidence: 99%

Using 2D/3D ultrasound observation of endometrial thickness, endometrial volume, and blood flow changes to predict the outcome of frozen embryo transfer cycles: a prospective study

Liu¹,

Yue²,

Wang³

et al. 2023

Quant Imaging Med Surg

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Background: Endometrial thickness (EMT) and blood flow are commonly used indicators of endometrial receptivity. However, the results of single ultrasound examination studies differ. Therefore, we used 3-dimensional (3D) ultrasound to study the influence of changes in EMT, endometrial volume, and endometrial blood flow on frozen embryo transfer cycles.Methods: This was a prospective cross-sectional study. Women who underwent in vitro fertilization (IVF) at Dalian Women and Children's Medical Group and met the inclusion criteria were enrolled between September 2020 and July 2021. Ultrasound examinations were performed in patients who underwent frozen embryo transfer cycles on the day of progesterone administration, the third day after progesterone administration, and the day of embryo transplantation. Two-dimensional ultrasound was used to record EMT, 3D ultrasound was used to record endometrial volume, and 3D power Doppler ultrasound imaging was used to record the following endometrial blood flow parameters: vascular index, flow index, and vascular flow index. Changes in the 3 inspections of the EMT, volume, vascular index, flow index, and vascular flow index and 2 inspections of estrogen levels were categorized as "declining" or "nondeclining". The relationship between changes in a certain indicator and the IVF outcome was analyzed by univariate analysis and multifactorial stepwise logistic regression.Results: In total, 133 patients were enrolled in this study, 48 were excluded, and 85 were included in the statistical analysis. Among these 85 patients, 61 were pregnant (71%), 47 had a clinical pregnancy (55%), and 39 had an ongoing pregnancy (45%). The results showed that if the first change in endometrial volume was nondeclining, the outcomes of clinical and ongoing pregnancies were more likely to be unfavorable (P=0.03, P=0.01). Additionally, if the second change in endometrial volume on the day of embryo transplantation was nondeclining, the outcome of an ongoing pregnancy was more likely to be favorable (P=0.03). Conclusions:The changes in endometrial volume was a factor helpful in predicting the IVF outcome, whereas the changes in EMT and endometrial blood flow analyses were not helpful in predicting IVF outcome.

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“…13 studies reported CP and/or OP rates with IUI-OS and IVF, with 7 RCTs, 4 retrospective cohorts and 2 prospective cohorts [ 31 , 34 – 38 40 , 41 – 44 , 48 , 49 ]. The differing outcomes create a mixed picture of evidence; all studies reporting OP concluded no difference between IUI-OS and IVF [ 31 , 40 – 42 , 44 , 48 ], while studies reporting CP had a higher number in favour of IVF [ 34 – 38 ].…”

Section: Iui Vs Ivf and Pregnancy Outcomesmentioning

confidence: 99%

Should IUI replace IVF as first-line treatment for unexplained infertility? A literature review

Man,

Parker,

Broughton

et al. 2023

BMC Women's Health

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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.

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Should intrauterine inseminations still be proposed in cases of unexplained infertility? Retrospective study and literature review

Cited by 8 publications

References 52 publications

The definition of unexplained infertility: A systematic review

The definition of unexplained infertility: A systematic review

Using 2D/3D ultrasound observation of endometrial thickness, endometrial volume, and blood flow changes to predict the outcome of frozen embryo transfer cycles: a prospective study

Should IUI replace IVF as first-line treatment for unexplained infertility? A literature review

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