Double versus single intrauterine insemination (IUI) in stimulation cycles of low-fertility couples
Rakic L, Kostova E, Cohlen BJ, Cantineau AEP Duplex versus single intrauterine insemination (IUI) in stimulation cycles of low-fertility couples. Cochrane Database of Systematic Reviews 2021, No. 7. Art. No.: CD003854. doi: 10.1002 /14651858.CD003854.pub2. Accessed July 30, 2021.
Description.
This study was conducted to determine the efficacy and safety of double intrauterine insemination (IUI) compared to single IUI in stimulation cycles in low fertility couples.
The main results were identified in nine studies of women with low fertility, but the evidence was of low quality. Limitations of the results include an unclear risk of bias, inconsistent results for some of the outcomes, and imprecision due to small trials with imprecise results.
They do not know whether double IUI improves fertility compared to single IUI. The evidence suggests that if the likelihood of having a baby after single IUI is 16%, the likelihood of having a baby after double IUI is between 12-27%. This result is similar according to a sensitivity analysis limited to only randomized controlled trials (RCTs) with a low risk of selection bias, they said.
It is unclear whether double IUIs reduce miscarriage rates compared to single IUIs, and there is evidence that the likelihood of a miscarriage following a single IUI is 1.5% and the likelihood following a double IUI is between 1.5% and 5%.
The reported clinical pregnancy rate per randomized woman may increase with a doubling of the IUI group, but this result should be interpreted with caution because the quality of the evidence is low and the consistency moderate.
This evidence suggests that the likelihood of a pregnancy following a single IUI is 14% and the likelihood following a double IUI is between 16-23%.
It is also unclear whether double IUIs affect the rate of multiple pregnancies compared to single IUIs, and evidence suggests that the likelihood of multiple pregnancies following a single IUI is 0.7% and the likelihood of following a double IUI is between 0.85% and 3.7%.
It is also unclear whether double IUIs affect ectopic pregnancy rates compared to single IUIs, with evidence that the likelihood of an ectopic pregnancy following a single IUI is 0.8% and the likelihood of following a double IUI is between 0.3 and 3.2%.
The authors conclude that
Our main analysis, in which the evidence is of low quality, shows that it is uncertain whether double IUI improves births and reduces miscarriages compared to single IUI. A sensitivity analysis limited to studies with a low risk of selection bias for both outcomes is consistent with the main analysis. Clinical pregnancy rates may be increased in the double IUI group, but this should be interpreted with caution because of the low quality of the evidence. It is unclear whether double IUI has an impact on multiple pregnancy rates and ectopic pregnancy rates compared to single IUI.
