Systematic review of the treatment of ovulatory infertility with clomiphene citrate and intrauterine insemination.
BACKGROUND
Controlled ovarian hyperstimulation (COH) with clomiphene citrate (CC) combined with intrauterine insemination (IUI) is often used as treatment for ovulatory infertility which includes unexplained, male, cervical, endometriosis, and tubal infertility.


OBJECTIVE
To review the effectiveness of CC and IUI in ovulatory infertility.


METHODS
Systematic review of pertinent randomised controlled trials (RCT) using the bibliographic databases MEDLINE and EMBASE. References of selected articles identified were hand-searched for additional relevant citations.


RESULTS
Six published RCT were included in the overall review. Meta-analysis demonstrated a higher cycle pregnancy rate (CPR) with CC and IUI compared to timed intercourse in the natural cycle (P < 0.001 and odds ratio = 4.6, 95% CI = 1.9-11.3). Treatment with gonadotrophins and IUI results in a higher CPR compared to CC and IUI (P = 0.005 and odds ratio = 2.9, 95% CI = 1.3-6.2). Further RCT are required comparing CC and IUI with IUI or CC alone before one can make firm conclusions.


CONCLUSIONS
Clomiphene citrate combined with IUI is more effective than timed intercourse in the natural cycle at achieving pregnancy in couples with ovulatory infertility. However, treatment with gonadotrophins and IUI is superior to CC and IUI.
Costello
Michael F
MF
Department of Reproductive Medicine and IVF Australia, Royal Hospital for Women, Randwick, Sydney, Australia. mfcostello@unsw.edu.au
D002996:Clomiphene / Q000627:therapeutic use*; D003075:Coitus; D005260:Female; D005300:Fertility Agents, Female / Q000627:therapeutic use*; D006062:Gonadotropins / Q000627:therapeutic use; D006801:Humans; D007247:Infertility, Female / Q000188:drug therapy*; D007315:Insemination, Artificial / Q000379:methods*; D008297:Male; D010062:Ovulation Induction / Q000379:methods*; D027724:Reproductive Techniques, Assisted
D005300:Fertility Agents, Female; D006062:Gonadotropins; D002996:Clomiphene