Intrauterine insemination catheters for assisted reproduction: a systematic review and meta-analysis

Influence of Catheter Type and Tenaculum Use on Intrauterine Insemination Outcome

Background

We investigated the impact of the choice of catheter type and tenaculum use on pregnancy related out- comes in intrauterine insemination (IUI) treatments.

Materials and Methods

A total of 338 consecutive IUI cycles were assessed in this retrospective study. Participants were divided according to the insemination technique - soft catheter (group 1; n=175), firm catheter (group 2; n=100), or tenaculum (group 3; n=63). Clinical, laboratory, semen parameters and pregnancy related outcomes were compared.

Results

Demographic characteristics and laboratory parameters were similar between the groups (P>0.05). The clini- cal pregnancy rate (CPR) was significantly higher in the firm catheter (19%, 19/100) and tenaculum (31.7%, 20/63) groups compared to the soft catheter group (5.1%, 9/175, P<0.001). There were no significant differences between the groups in live birth and miscarriage rates per clinical pregnancy (P>0.05).

Conclusion

Our findings indicate that the use of a firm catheter or tenaculum for IUI might result in a higher CPR, but might not have a considerable effect on the live birth rate (LBR). Further prospective randomized studies are required to determine the long-term effects of the catheter type or tenaculum use on IUI success.

Risk of pelvic inflammatory disease after intrauterine insemination: a systematic review

The aim of this study was to ascertain the incidence of pelvic inflammatory disease (PID) after intrauterine insemination (IUI). A systematic review was conducted using three different approaches: a search of IUI registries; a search of published meta-analyses; and a search of prospective randomized trials. Search terms were 'IUI', 'complications', 'infection' and 'PID'. Two IUI registers were identified that met the inclusion criteria, totalling 365,874 cycles, with 57 PID cases being reported. The post-IUI PID rate was 0.16/1000 (95% CI 0.2 to 0.3/1000). The frequency was higher in husband sperm cycles (0.21/1000) (28/135,839) than in donor sperm cycles (0.03/1000) (1/33,712) (P < 0.05; OR 6.95). Nineteen meta-analyses were retrieved, which included 156 trials, totalling 43,048 cycles, with no PID case being reported. Seventeen prospective clinical trials published between 2013 and 2014 were identified, totalling 4968 cycles; no PID case was reported. The reported rate of post-IUI clinical PID is low (0.16/1000), about 40% higher than reported in the general population of women during their reproductive life. No antibiotic prophylaxis should be recommended unless there is an associated risk factor.

Soft versus firm catheters for intrauterine insemination

BACKGROUND

Intrauterine insemination (IUI) is a recommended treatment for unexplained subfertility. The treatment involves the direct delivery of spermatozoa into the uterus using a catheter. Many factors influence the success of IUI treatments including the type of catheter used.

OBJECTIVES

To compare pregnancy-related outcomes from women undergoing intrauterine insemination cycles performed with either soft or firm catheters in subfertile women.

SEARCH STRATEGY

We searched the following databases (inception to July 2010) with no language restrictions: Cochrane Menstrual Disorders and Subfertility Group Specialised Register, CENTRAL (The Cochrane Library), MEDLINE, EMBASE, PsycINFO, CINAHL, LILACS and OpenSigle. We also searched the conference abstracts in the ISI Web of Knowledge and Google, and conference abstracts and citation lists of relevant publications, reviews and included studies.

SELECTION CRITERIA

We included only truly randomised controlled studies of women who underwent IUI using either soft or firm catheter types and reporting data on rates of live birth, clinical pregnancy, multiple pregnancy, miscarriage, ease of introduction of the catheter, occurrence of trauma, or woman's discomfort.

DATA COLLECTION AND ANALYSIS

Two review authors screened the titles and abstracts of 78 potentially eligible studies and excluded 66 of these. We critically appraised the full texts of twelve studies and excluded three studies. Nine publications of six studies were remaining. We extracted data from the six remaining studies and there were no disagreements. We assessed risk of bias and pooled dichotomous data and presented the Peto odds ratios (OR) with 95% confidence intervals (CI).

MAIN RESULTS

There was no evidence of a significant effect difference regarding the choice of catheter type for any of the outcomes. Three studies reported live birth rates (OR 0.94, 95% CI 0.65 to 1.35) with a translated OR percentages (1.3, 95% CI 0.56 to 3.1) while six studies reported clinical pregnancy rates (OR 1.0, 95% CI 0.73 to 1.35 ). Two studies were pooled for the analysis of miscarriages (OR 1.25, 95% CI 0.49 to 3.22). Results of other adverse outcomes were reported per cycle and were therefore not pooled.

AUTHORS' CONCLUSIONS

On the basis of the evidence available in this review, no specific conclusion can be made regarding the superiority of one catheter class over another. Further adequately powered studies reporting on clinical outcomes (e.g. live birth rate) are required. Additional outcomes such as miscarriage rates and measures of discomfort need to be reported.

Intrauterine insemination and male subfertility

In this article we define male subfertility, review clinical indications for the use of intrauterine insemination, evaluate insemination preparation and administration technique, and ultimately advocate for its use as a first-line therapy in the treatment of infertile couples with male subfertility.