Summary of findings for the main comparison. IVF compared with expectant management for unexplained subfertility.
| IVF compared with expectant management for unexplained subfertility | ||||||
| Population: women with unexplained subfertility Settings: fertility clinic Intervention: IVF Comparison: expectant management | ||||||
| Outcomes | Plain language summary | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | Number of participants (studies) | Quality of the evidence (GRADE) | |
| Assumed risk | Corresponding risk | |||||
| Expectant management | IVF | |||||
| Live birth rate per woman IVF vs expectant management | There is inconclusive evidence to suggest that IVF may result in more births than expectant management | 37 per 1000 | 458 per 1000 (90 to 879) | OR 22 (2.56 to 189.37) | 51 (1 study) | ⊕⊝⊝⊝ Very lowa |
| Pregnancy rate per woman IVF vs expectant management | There is inconclusive evidence to suggest that IVF may result in more clinical pregnancies than expectant management | 127 per 1000 | 320 per 1000 (135 to 588) | OR 3.24 (1.07 to 9.8) | 86 (2 studies) | ⊕⊝⊝⊝ Very lowa |
| Multiple pregnancy rate | Not reported in the included studies | |||||
| *The basis for the assumed risk is the median control group risk across studies. 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; IVF: In vitro fertilisation; 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. | ||||||
aThe GRADE quality rating was downgraded by 3 levels due to very serious imprecision, questionable applicability and (for the analysis of clinical pregnancy) serious inconsistency. Very few events were reported in the included studies (12 births and 18 pregnancies altogether). There was also substantial statistical heterogeneity (I2=80%) in the analysis of clinical pregnancies (with differing directions of effect) and applicability was unclear due to the long duration of unexplained infertility and use of co‐interventions.