Summary of findings 3. IVF compared with IUI + superovulation for unexplained subfertility.
| IVF compared with IUI + superovulation for unexplained subfertility | ||||||
| Population: women with unexplained subfertility Setting: fertility clinic Intervention: IVF Comparison: IUI + superovulation | ||||||
| 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 | |||||
| IUI + superovulation | IVF | |||||
|
Live birth rate in treatment‐naive women IVF vs IUI + gonadotropins |
In treatment‐naive women there is no conclusive evidence of a difference in live birth rates between IVF and insemination using injectable fertility drugs | 273 per 1000 | 308 per 1000 (264 to 360) | OR 1.27 (0.94 to 1.73) |
745 (4 studies) | ⊕⊕⊕⊝ Moderatea |
|
Live birth rate in pretreated women IVF vs IUI + gonadotropins |
In women pretreated with oral fertility drugs IVF leads to more live births than insemination using injectable fertility drugs | 219 per 1000 | 523 per 1000 (374 to 731) | OR 3.90 (2.32 to 6.57) |
280 (1 study) | ⊕⊕⊕⊝ Moderateb |
|
Live birth rate in treatment‐naive women IVF vs IUI + CC |
In treatment‐naive women there is no conclusive evidence of a difference in live birth rates between IVF and insemination using injectable fertility drugs | 154 per 1000 | 314 per 1000 (148 to 668) | OR 2.51 (0.96 to 6.55) |
103 (1 study) | ⊕⊕⊝⊝ Lowc |
| Multiple pregnancy rate | In treatment‐naive women there is no evidence of a difference in multiple pregnancy rates between IVF and insemination using injectable fertility drugs | 58 per 1000 | 47 per 1000 (28 to 78) | OR 0.81 (0.47 to 1.39) | 848 (4 studies) | ⊕⊕⊕⊝ Moderated |
| Incidence of OHSS | In treatment‐naive women there is no evidence of a difference in OHSS rates between IVF and insemination using injectable fertility drugs | 58 per 1000 | 66 per 1000 (26 to 158) | OR 1.15 (0.43 to 3.06) | 324 (2 studies) | ⊕⊕⊝⊝ Lowe |
| *The basis for the assumed risk is the median risk in the control groups. 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). CC: Clomiphene citrate; CI: Confidence interval; IUI: Intrauterine insemination; IVF: In vitro fertilisation; OHSS: Ovarian hyperstimulation syndrome; OR: Odds ratio ;RR: Risk 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 1 level due to serious imprecision: the confidence interval is compatible with no difference between the interventions or with meaningful benefit from IVF. bThe GRADE quality rating was downgraded by 1 level due to the relatively small number of events (n=97) in the single included trial.
cThe GRADE quality rating was downgraded by 2 levels due to very serious imprecision: there were only 24 events and the confidence interval is compatible with no difference between the interventions or with meaningful benefit from IVF
dThe GRADE quality rating was downgraded by 1 level due to serious imprecision: the confidence interval is compatible with no difference between the interventions or with meaningful benefit in either arm. eThe GRADE quality rating was downgraded by 2 levels due to serious imprecision, risk of bias in one trial and the small number of events in the included trials. The confidence interval is compatible with no difference between the interventions or with meaningful benefit in either arm.