Cantineau Astrid E P, Cohlen Ben J, Heineman Maas Jan
Department of Obstetrics & Gynaecology , University Medical Centre, Slachthuisstraat 27, Groningen, Netherlands, 9713 MA.
Cochrane Database Syst Rev. 2009 Apr 15(2):CD001502. doi: 10.1002/14651858.CD001502.pub3.
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.
To investigate whether pregnancy and live birth outcomes differ between fallopian tube sperm perfusion and intrauterine insemination in the treatment of non-tubal subfertility.
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.
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.
Two review authors independently selected the trials for inclusion based on the quality of the studies.
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.
控制性卵巢过度刺激（COH）联合宫腔内人工授精（IUI）常用于输卵管未受累的不育夫妇。另一种方法是输卵管内精子灌注（FSP）。该技术可确保排卵时输卵管内的精子密度高于标准IUI。本综述的目的是确定FSP和IUI在提高受孕几率方面是否存在差异。
探讨输卵管内精子灌注与宫腔内人工授精在治疗非输卵管性不育时，妊娠及活产结局是否存在差异。
我们检索了月经失调与不育症研究组试验注册库（2008年10月）、MEDLINE（1966年1月至2008年10月）和EMBASE（1988年1月至2008年10月）。使用相同的关键词检索了美国生殖医学学会（1987年至2008年）和欧洲人类生殖与胚胎学会（1987年至2008年）会议的摘要。
本综述仅纳入比较FSP与IUI的真正随机对照研究。纳入至少已尝试受孕一年的非输卵管性不育夫妇。
两位综述作者根据研究质量独立选择纳入试验。
荟萃分析纳入了八项涉及595对夫妇的研究。仅有一项研究报告了活产率，且无证据表明FSP与IUI之间存在差异（比值比1.2，95%可信区间0.39至3.5）。每对夫妇的临床妊娠方面，无证据表明FSP与IUI之间存在差异（比值比1.2，95%可信区间0.79至1.7）。仅纳入不明原因不育夫妇的亚组分析（n = 239）未报告FSP与IUI之间存在任何差异（比值比1.6，95%可信区间0.89至2.8）。
对于非输卵管性不育，结果表明FSP并不比IUI有明显优势。因此，就非输卵管性不育治疗中FSP与IUI的比较使用向不育夫妇提供的建议应反映这一点。
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