Intrauterine insemination versus fallopian tube sperm perfusion for non-tubal infertility

Cantineau AEP, Cohlen BJ, Heineman MJ

Published Online:

April 15, 2009

It remains unclear whether fallopian tube sperm perfusion (FSP) is better than intrauterine insemination (IUI) for non-tubal infertility. Intrauterine insemination (IUI) is an assisted reproduction procedure that places sperm directly into the uterus. Fallopian tube sperm perfusion (FSP) is a similar procedure that places sperm into the woman's fallopian tube, closer to the eggs than IUI, in order to improve the chances of conception. Results of this review of randomised controlled trials indicate that it is unclear whether FSP leads to increased pregnancy rates compared to IUI in couples with non-tubal infertility. The type of catheter used to place sperm in the fallopian tube may be important.

(Synopsis prepared by Menstrual Disorders and Subfertility Review Group)

Abstract (click to read)

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.

Objectives:

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

Search strategy:

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.

Selection criteria:

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.

Data collection and analysis:

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

Main 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).

Authors' 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.

This record should be cited as:

Cantineau AEP, Cohlen BJ, Heineman MJ. Intra-uterine insemination versus fallopian tube sperm perfusion for non-tubal infertility. Cochrane Database of Systematic Reviews 2009, Issue 2. Art. No.: CD001502. DOI: 10.1002/14651858.CD001502.pub3

Assessed as up to date:

December 6, 2007

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Primary Review Group:

Menstrual Disorders and Subfertility Group

Health topics:

Gynaecology > Subfertility > Female: unexplained

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Intrauterine insemination versus fallopian tube sperm perfusion for non-tubal infertility

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