Pregnancy rates after intrauterine insemination in moderate to severe endometriosis: A systematic review and meta-analysis of observational studies

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Abstract

To evaluate the efficacy and safety of intrauterine insemination (IUI) in moderate to severe endometriosis patients, a systematic review and meta-analysis was conducted since the role of this treatment strategy in these patients is a matter of debate in the literature. Systematic searches were performed in PubMed, EMBASE, Cinahl, and The Cochrane Library from inception to September 1, 2016. Studies including moderate to severe endometriosis patients reporting pregnancy rates after IUI were selected. The primary outcome was live birth after IUI treatment compared to expectant management. Secondary noncomparative outcomes were live birth and clinical pregnancy, which were presented as weighed mean pregnancy rates. Nineteen articles (2 unclear design, 11 retrospective, 6 prospective) were included for the analysis. Our primary outcome measure was only addressed by one study, showing an odds ratio of 1.77 (95% confidence interval [CI], 0.86-3.63) on live birth favoring IUI versus no treatment. The calculated weighed mean live birth and clinical pregnancy rate per patient was 20.3% (95% CI, 11.2-29.4) and 32.7% (95% CI, 21.3- 44.0), respectively. This meta-analysis of observational data showed that IUI could be a feasible treatment in moderate to severe endometriosis. Whether this treatment should be structurally offered prior to in vitro fertilization needs to be investigated in a randomized, controlled trial, including time-to-pregnancy, safety, and cost-effectiveness.

Original languageEnglish
Pages (from-to)158-167
Number of pages10
JournalJournal of Endometriosis and Pelvic Pain Disorders
Volume9
Issue number3
DOIs
Publication statusPublished - 1 Jul 2017

Cite this

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title = "Pregnancy rates after intrauterine insemination in moderate to severe endometriosis: A systematic review and meta-analysis of observational studies",
abstract = "To evaluate the efficacy and safety of intrauterine insemination (IUI) in moderate to severe endometriosis patients, a systematic review and meta-analysis was conducted since the role of this treatment strategy in these patients is a matter of debate in the literature. Systematic searches were performed in PubMed, EMBASE, Cinahl, and The Cochrane Library from inception to September 1, 2016. Studies including moderate to severe endometriosis patients reporting pregnancy rates after IUI were selected. The primary outcome was live birth after IUI treatment compared to expectant management. Secondary noncomparative outcomes were live birth and clinical pregnancy, which were presented as weighed mean pregnancy rates. Nineteen articles (2 unclear design, 11 retrospective, 6 prospective) were included for the analysis. Our primary outcome measure was only addressed by one study, showing an odds ratio of 1.77 (95{\%} confidence interval [CI], 0.86-3.63) on live birth favoring IUI versus no treatment. The calculated weighed mean live birth and clinical pregnancy rate per patient was 20.3{\%} (95{\%} CI, 11.2-29.4) and 32.7{\%} (95{\%} CI, 21.3- 44.0), respectively. This meta-analysis of observational data showed that IUI could be a feasible treatment in moderate to severe endometriosis. Whether this treatment should be structurally offered prior to in vitro fertilization needs to be investigated in a randomized, controlled trial, including time-to-pregnancy, safety, and cost-effectiveness.",
keywords = "Endometriosis, Intrauterine insemination, Meta-analysis, Pregnancy, Recurrence",
author = "{van der Houwen}, {Lisette E.E.} and Schreurs, {Anneke M.F.} and Roel Schats and Pam Kaspers and Lambalk, {Cornelis B.} and Hompes, {Peter G.A.} and Velja Mijatovic",
year = "2017",
month = "7",
day = "1",
doi = "10.5301/jeppd.5000299",
language = "English",
volume = "9",
pages = "158--167",
journal = "Journal of Endometriosis and Pelvic Pain Disorders",
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TY - JOUR

T1 - Pregnancy rates after intrauterine insemination in moderate to severe endometriosis

T2 - A systematic review and meta-analysis of observational studies

AU - van der Houwen, Lisette E.E.

AU - Schreurs, Anneke M.F.

AU - Schats, Roel

AU - Kaspers, Pam

AU - Lambalk, Cornelis B.

AU - Hompes, Peter G.A.

AU - Mijatovic, Velja

PY - 2017/7/1

Y1 - 2017/7/1

N2 - To evaluate the efficacy and safety of intrauterine insemination (IUI) in moderate to severe endometriosis patients, a systematic review and meta-analysis was conducted since the role of this treatment strategy in these patients is a matter of debate in the literature. Systematic searches were performed in PubMed, EMBASE, Cinahl, and The Cochrane Library from inception to September 1, 2016. Studies including moderate to severe endometriosis patients reporting pregnancy rates after IUI were selected. The primary outcome was live birth after IUI treatment compared to expectant management. Secondary noncomparative outcomes were live birth and clinical pregnancy, which were presented as weighed mean pregnancy rates. Nineteen articles (2 unclear design, 11 retrospective, 6 prospective) were included for the analysis. Our primary outcome measure was only addressed by one study, showing an odds ratio of 1.77 (95% confidence interval [CI], 0.86-3.63) on live birth favoring IUI versus no treatment. The calculated weighed mean live birth and clinical pregnancy rate per patient was 20.3% (95% CI, 11.2-29.4) and 32.7% (95% CI, 21.3- 44.0), respectively. This meta-analysis of observational data showed that IUI could be a feasible treatment in moderate to severe endometriosis. Whether this treatment should be structurally offered prior to in vitro fertilization needs to be investigated in a randomized, controlled trial, including time-to-pregnancy, safety, and cost-effectiveness.

AB - To evaluate the efficacy and safety of intrauterine insemination (IUI) in moderate to severe endometriosis patients, a systematic review and meta-analysis was conducted since the role of this treatment strategy in these patients is a matter of debate in the literature. Systematic searches were performed in PubMed, EMBASE, Cinahl, and The Cochrane Library from inception to September 1, 2016. Studies including moderate to severe endometriosis patients reporting pregnancy rates after IUI were selected. The primary outcome was live birth after IUI treatment compared to expectant management. Secondary noncomparative outcomes were live birth and clinical pregnancy, which were presented as weighed mean pregnancy rates. Nineteen articles (2 unclear design, 11 retrospective, 6 prospective) were included for the analysis. Our primary outcome measure was only addressed by one study, showing an odds ratio of 1.77 (95% confidence interval [CI], 0.86-3.63) on live birth favoring IUI versus no treatment. The calculated weighed mean live birth and clinical pregnancy rate per patient was 20.3% (95% CI, 11.2-29.4) and 32.7% (95% CI, 21.3- 44.0), respectively. This meta-analysis of observational data showed that IUI could be a feasible treatment in moderate to severe endometriosis. Whether this treatment should be structurally offered prior to in vitro fertilization needs to be investigated in a randomized, controlled trial, including time-to-pregnancy, safety, and cost-effectiveness.

KW - Endometriosis

KW - Intrauterine insemination

KW - Meta-analysis

KW - Pregnancy

KW - Recurrence

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U2 - 10.5301/jeppd.5000299

DO - 10.5301/jeppd.5000299

M3 - Review article

VL - 9

SP - 158

EP - 167

JO - Journal of Endometriosis and Pelvic Pain Disorders

JF - Journal of Endometriosis and Pelvic Pain Disorders

SN - 2284-0265

IS - 3

ER -