Summary of findings 3. IUI in a stimulated cycle compared to TI or expectant management in a natural cycle for unexplained subfertility.
| IUI in stimulated cycle compared to TI or expectant management in natural cycle for unexplained subfertility | ||||||
| Patient or population: participants with unexplained subfertility Settings: fertility clinic Intervention: IUI in stimulated cycle Comparison: TI or expectant management in natural cycle | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No of Participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| TI or expectant management in a natural cycle | IUI in a stimulated cycle | |||||
| Live birth rate per couple (all cycles)‐ clomiphene citrate or letrozole | 90 per 1000 | 307 per 1000 (165 to 497) | OR 4.48 (2 to 10.01) | 201 (1 study) | ⊕⊕⊕⊝ moderatea | ‐ |
| Live birth rate per couple (all cycles)‐ clomiphene citrate or gonadotropins | 238 per 1000 | 204 per 1000 (123 to 318) | OR 0.82 (0.45 to 1.49) | 253 (1 study) | ⊕⊕⊝⊝ lowb | ‐ |
| Multiple pregnancy rate per couple | 4 per 1000 | 13 per 1000 (2 to 79) | OR 3.01 (0.47 to 19.28) | 454 (2 studies) | ⊕⊕⊝⊝ lowb | ‐ |
| Pregnancy rate per couple (all cycles)‐ clomiphene citrate or letrozole | 110 per 1000 | 366 per 1000 (215 to 549) | OR 4.68 (2.22 to 9.86) | 201 (1 study) | ⊕⊕⊕⊝ moderatea | ‐ |
| Ovarian hyperstimulation syndrome rate per woman | See comment | See comment | See comment | See comment | See comment | No events in intervention or control groups |
| Miscarriage rate per couple | 31 per 1000 | 84 per 1000 (36 to 183) | OR 2.87 (1.18 to 7.01) | 454 (2 studies) | ⊕⊕⊕⊝ moderatea | ‐ |
| Ectopic pregnancy rate per couple | Not estimable (no events in intervention group) | ‐ | OR 9.28 (0.49 to 174.6) | 201 (1 study) | ⊕⊕⊝⊝ lowb | ‐ |
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; OR: Odds ratio; | ||||||
| GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate. | ||||||
aDowngraded by one level for serious imprecision: small sample size with a low event rate. bDowngraded by two levels for very serious imprecision: small sample size with a low event rate and effect estimate with a wide confidence interval.