Intra-uterine insemination versus fallopian tube sperm perfusion for non-tubal infertility.
BACKGROUND
Controlled ovarian hyperstimulation (COH) combined with intrauterine insemination (IUI) is commonly offered to couples with subfertility that does not involve the fallopian tubes. Another method is fallopian tube sperm perfusion (FSP). This technique ensures the presence of higher sperm densities in the fallopian tubes at the time of ovulation than does standard IUI. The aim of this review was to determine whether FSP and IUI differ in improving the probability of conception.


OBJECTIVE
To investigate whether pregnancy and live birth outcomes differ between fallopian tube sperm perfusion and intrauterine insemination in the treatment of non-tubal subfertility.


METHODS
We searched the Menstrual Disorders and Subfertility Group Trials Register (October 2008), MEDLINE (January 1966 to October 2008), and EMBASE (January 1988 to October 2008). Abstracts of the American Society for Reproductive Medicine (1987 to 2008) and European Society for Human Reproduction and Embryology (1987 to 2008) meetings were searched using the same key or text words.


METHODS
Only truly randomised controlled studies comparing FSP with IUI were included in this review. Couples with non-tubal subfertility who have been trying to conceive for at least one year were included.


METHODS
Two review authors independently selected the trials for inclusion based on the quality of the studies.


RESULTS
Eight studies involving 595 couples were included in the meta-analysis. Only one study reported the live birth rate and there was no evidence of a difference between FSP and IUI (OR 1.2, 95% CI 0.39 to 3.5). There was no evidence of a difference between FSP and IUI for clinical pregnancy per couple (OR 1.2, 95% CI 0.79 to 1.7). A subgroup analysis which included couples with unexplained subfertility only (n = 239) did not report any difference between FSP and IUI (OR 1.6, 95% CI 0.89 to 2.8).


CONCLUSIONS
For non-tubal subfertility, the results indicate no clear benefit for FSP over IUI. Therefore the advice offered to subfertile couples regarding the comparative use of FSP versus IUI in the treatment of non-tubal subfertility should reflect this.
Cantineau
Astrid E P
AE
Department of Obstetrics & Gynaecology , University Medical Centre, Slachthuisstraat 27, Groningen, Netherlands, 9713 MA. aepcantineau@gmail.com
Cohlen
Ben J
BJ
Heineman
Maas Jan
MJ
D005187:Fallopian Tubes; D005260:Female; D006801:Humans; D007247:Infertility, Female; D011247:Pregnancy; D011256:Pregnancy Outcome; D016032:Randomized Controlled Trials as Topic; D027724:Reproductive Techniques, Assisted; D013076:Sperm Count