What is the best timing technique for intrauterine insemination

Cantineau AEP, Janssen MJ, Cohlen BJ

Published Online:

April 14, 2010

It remains unclear which technique of timing for intrauterine insemination results in the best treatment outcome, a live birth. Intrauterine insemination (IUI) is an assisted reproduction procedure that places sperm directly into the uterus. Timing of IUI can be performed with hormone (luteinising hormone) detection in urine or blood, human chorionic gonadotropin (hCG) injection and other more infrequently used methods. Results of this review of randomised controlled trials indicate there is no difference in live birth rates between timing methods, but the amount of evidence is scarce. The optimal moment for the actual insemination in relation to either luteinising hormone (LH) surge or hCG administration is also unclear.

Abstract (click to read)

Background:

Intrauterine insemination (IUI) should logically be performed around the moment of ovulation. Since spermatozoa and oocytes have only limited survival times correct timing is essential. As it is not known which technique of timing for IUI results in the best treatment outcome, we compared different techniques for timing IUI and different time intervals.

Objectives:

To evaluate the effectiveness of different synchronisation methods in natural and stimulated cycles for IUI in subfertile couples.

Search strategy:

We searched for all publications which described randomised controlled trials of the timing of IUI. We searched the Cochrane Menstrual Disorders and Subfertility Group Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library), (1966 to March 2009), EMBASE (1974 to March 2009) and Science Direct (1966 to March 2009) electronic databases. Furthermore, we checked the reference lists of all obtained studies and performed a handsearch of conference abstracts.

Selection criteria:

Only truly randomised controlled trials comparing different timing methods for IUI were included. The following interventions were evaluated: detection of luteinising hormone (LH) in urine or blood, single test; human chorionic gonadotropin (hCG) administration; combination of LH detection and hCG administration; basal body temperature chart; ultrasound detection of ovulation; gonadotropin-releasing hormone (GnRH) agonist administration; or other timing methods.

Data collection and analysis:

Two review authors independently selected the trials to be included according to the above mentioned criteria. We performed statistical analyses in accordance with the guidelines for statistical analysis developed by The Cochrane Collaboration.

Main results:

Ten studies were included comparing urinary LH surge versus hCG injection; recombinant hCG versus urinary hCG; and hCG versus a GnRH agonist. One study compared the optimum time interval from hCG injection to IUI. The results of these studies showed no significant differences between different timing methods for IUI expressed as live birth rates: hCG versus LH surge (odds ratio (OR) 1.0, 95% CI 0.06 to 18); urinary hCG versus recombinant hCG (OR 1.2, 95% CI 0.68 to 2.0); and hCG versus GnRH agonist (OR 1.1, 95% CI 0.42 to 3.1). All the secondary outcomes analysed showed no significant differences between treatment groups.

Authors' conclusions:

There is no evidence to advise one particular treatment option over another. The choice should be based on hospital facilities, convenience for the patient, medical staff, costs and drop-out levels. Since different time intervals between hCG and IUI did not result in different pregnancy rates, a more flexible approach might be allowed.

This record should be cited as:

Cantineau AEP, Janssen MJ, Cohlen BJ. Synchronised approach for intrauterine insemination in subfertile couples.. Cochrane Database of Systematic Reviews 2010, Issue 4. Art. No.: CD006942. DOI: 10.1002/14651858.CD006942.pub2

Assessed as up to date:

July 6, 2009

Find the research

Get full text at The Cochrane Library

Primary Review Group:

Menstrual Disorders and Subfertility Group

Health topics:

Gynaecology > Subfertility > Female: other

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

What is the best timing technique for intrauterine insemination

More like this

Copyright © 2012 - The Cochrane Collaboration