Intrauterine insemination + controlled ovarian hyperstimulation versus in vitro fertilisation in unexplained infertility: a systematic review and meta-analysis.

Background: IUI + COH is widely used in cases of unexplained infertility before resorting to IVF. Debate continues about what should be the first-line treatment for couples with unexplained infertility. Objectives: This systematic review assessed the relative efficacy of IUI + COH compared with IVF in couples with unexplained infertility. Search strategy: We searched Medline, Embase, CIHNL, Pscy Info, and Cochrane Library from 1980 to November 2019. Selection criteria: Only RCTs published articles in full text with female patients aged 18–43 years and diagnosed with unexplained infertility were included. Data collection and analysis: Two authors reviewed citations from primary search independently and any disagreement was resolved by mutual discussion and consultation with a third author. Main result: In total, eight RCTs were included. The quality of evidence was moderate to low due to inconsistency across the trials and imprecision. The pooled result showed that IVF was associated with a statistically significant higher live birth rate (RR 1.53, 95% CI 1.01–2.32, P < 0.00001 I2 = 86%) with no significant difference in multiple pregnancy rate or OHSS rate. Sensitivity analysis based on women's age and a history of previous IUI or IVF treatment showed no significant difference in the live birth rates (RR 1.01, 95% CI 0.88–1.15, I2 = 0%, 3 RCTs) in treatment-naïve women younger than 38 years. In women over 38 years, the live birth rates were significantly higher in the IVF group (RR 2.15, 95% CI 1.16–4.0, I2 = 42%, 1 RCT). Conclusion: Further research using a standardised treatment protocol and taking into account important prognostic variables and cumulative live birth rates from fresh IVF and all sibling frozen embryos is required to further guide clinical practice. [ABSTRACT FROM AUTHOR]