Human chorionic gonadotropin administration vs. luteinizing monitoring for intrauterine insemination timing, after administration of clomiphene citrate: a meta-analysis.
OBJECTIVE
To systematically compare hCG administration as a method for intrauterine insemination (IUI) timing with conservative urinary LH surge detection in infertility treatment.


METHODS
Meta-analysis of prospective and retrospective trials.


METHODS
Tertiary fertility and IVF center.


METHODS
One thousand four hundred sixty-one patients who received hCG after a clomiphene citrate regimen, compared with 1,162 patients who had an LH surge detection for IUI timing.


METHODS
Both MEDLINE and Cochrane Collaboration were searched. References of retrieved articles were included in the search. The meta-analysis included all controlled trials examining the effectiveness of hCG administration before IUI on clinical-pregnancy rates in comparison with LH detection. Two independent reviewers performed data extraction.


METHODS
Pregnancy rates.


RESULTS
Seven studies with 2,623 patients were included in the meta-analysis (1,461 patients received hCG, and 1,162 had LH surge detection). When all studies were combined, patients who received hCG before IUI demonstrated lower clinical-pregnancy rates than did women who had IUI after spontaneous ovulation (odds ratio, 0.74; 95% confidence interval, 0.57-0.961). In subgroup analysis of studies that considered ovulatory dysfunction to be the infertility reason, the results favored women who received hCG. In contrast, across studies that reported male factor as the infertility reason, as well as across studies including women with unexplained infertility, results appeared to favor the LH surge detection approach. However, none of those subgroup analyses reached statistical significance.


CONCLUSIONS
Available data do not demonstrate a consistent, clinically important benefit of hCG-induced ovulation compared with spontaneous ovulation for IUI timing.
Kosmas
Ioannis P
IP
Centre for Reproductive Medicine, Dutch-Speaking Brussels Free University, Brussels, Belgium. kosmasioannis@gmail.com <kosmasioannis@gmail.com>
Tatsioni
Athina
A
Fatemi
Human Musavi
HM
Kolibianakis
Efstratios M
EM
Tournaye
Herman
H
Devroey
Paul
P
D000328:Adult; D006063:Chorionic Gonadotropin / Q000008:administration & dosage*; D002996:Clomiphene / Q000627:therapeutic use*; D005260:Female; D005300:Fertility Agents, Female / Q000627:therapeutic use*; D006801:Humans; D007248:Infertility, Male / Q000628:therapy; D007315:Insemination, Artificial; D007986:Luteinizing Hormone / Q000652:urine*; D008297:Male; D006080:Ovarian Follicle / Q000000981:diagnostic imaging; D010062:Ovulation Induction / Q000379:methods*; D011247:Pregnancy; D018873:Pregnancy Rate; D014463:Ultrasonography
D006063:Chorionic Gonadotropin; D005300:Fertility Agents, Female; D002996:Clomiphene; D007986:Luteinizing Hormone