Department of Obstetrics and Gynecology, The University of British Columbia, Vancouver, BC, Canada.
Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, McGill University Health Care Centre, Montreal, QC, Canada.
BJOG. 2019 Jan;126(2):227-235. doi: 10.1111/1471-0528.15457. Epub 2018 Oct 24.
Fallopian tube occlusion is a common cause of infertility, but the effect of unilateral tubal block (UTB) on pregnancy rates (PR) after controlled ovarian hyperstimulation and intrauterine insemination (COH-IUI) remains controversial.
To evaluate PR after COH-IUI among infertile women with proximal and distal UTB diagnosed by hysterosalpingogram (HSG), compared against women with bilateral patent tubes experiencing unexplained infertility.
We searched EMBASE, MEDLINE, Google Scholar, Cochrane Library, and PUBMED from inception to 14 January 2018.
Studies that report PR/cycle or cumulative PR among women with UTB and controls were included.
Two authors independently selected and extracted study characteristics and data. Methodological quality was assessed using the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines.
Among 2965 patients and 5749 IUI cycles across ten studies, no significant difference in PR/cycle (odds ratio, OR = 0.88; 95% confidence interval, 95% CI = 0.69-1.12) and cumulative PR (OR = 0.80, 95% CI = 0.62-1.04) was observed. Patients with proximal UTB demonstrated similar PR/cycle (OR = 1.06, 95% CI = 0.68-1.66) and cumulative PR (OR = 1.10, 95% CI = 0.75-1.62), compared with controls, whereas patients with distal UTB had significantly lower cumulative PR (OR = 0.49, 95% CI = 0.25-0.97, P = 0.04). Patients with proximal block also demonstrated significantly improved cumulative PR, compared with patients with distal block (OR=2.41, 95% CI = 1.37-4.25, P = 0.002).
Infertile patients with proximal UTB diagnosed by HSG can expect similar pregnancy rates after COH-IUI, compared with those with bilateral tubal patency and unexplained infertility, whereas patients with distal UTB have lower odds of pregnancy. These differences may reflect inherent diagnostic limitations of HSG or differences in underlying pathologies.
Meta-analysis evaluates pregnancy outcomes after COH-IUI in women with unilateral tubal block diagnosed by HSG.
输卵管阻塞是不孕的常见原因，但输卵管单侧阻塞（UTB）对控制性卵巢过度刺激和宫腔内人工授精（COH-IUI）后妊娠率（PR）的影响仍存在争议。
通过子宫输卵管造影（HSG）诊断近端和远端 UTB 的不孕妇女在 COH-IUI 后的 PR 与双侧通畅且不明原因不孕的妇女进行比较。
我们从建库至 2018 年 1 月 14 日在 EMBASE、MEDLINE、Google Scholar、Cochrane 图书馆和 PUBMED 中进行了检索。
纳入报告 UTB 妇女和对照组 PR/周期或累积 PR 的研究。
两位作者独立选择和提取研究特征和数据。使用系统评价和荟萃分析的首选报告项目（PRISMA）指南评估方法学质量。
在 10 项研究的 2965 名患者和 5749 次 IUI 周期中，PR/周期（优势比，OR=0.88；95%置信区间，95%CI=0.69-1.12）和累积 PR（OR=0.80，95%CI=0.62-1.04）无显著差异。与对照组相比，近端 UTB 患者的 PR/周期（OR=1.06，95%CI=0.68-1.66）和累积 PR（OR=1.10，95%CI=0.75-1.62）相似，而远端 UTB 患者的累积 PR 显著降低（OR=0.49，95%CI=0.25-0.97，P=0.04）。与远端阻塞相比，近端阻塞患者的累积 PR 也显著提高（OR=2.41，95%CI=1.37-4.25，P=0.002）。
通过 HSG 诊断为近端 UTB 的不孕患者在 COH-IUI 后的妊娠率与双侧输卵管通畅且不明原因不孕的患者相似，而远端 UTB 患者妊娠的可能性较低。这些差异可能反映了 HSG 的固有诊断局限性或潜在病理的差异。
荟萃分析评估了通过 HSG 诊断为单侧输卵管阻塞的妇女在 COH-IUI 后的妊娠结局。
