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Systematic review of the treatment of ovulatory infertility with clomiphene citrate and intrauterine insemination
Author(s) -
Costello Michael F.
Publication year - 2004
Publication title -
australian and new zealand journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.734
H-Index - 65
eISSN - 1479-828X
pISSN - 0004-8666
DOI - 10.1111/j.1479-828x.2004.00192.x
Subject(s) - medicine , controlled ovarian hyperstimulation , infertility , gynecology , unexplained infertility , intrauterine insemination , randomized controlled trial , obstetrics , clomifene , pregnancy rate , pregnancy , artificial insemination , odds ratio , ovulation induction , natural cycle , biology , genetics
Background: Controlled ovarian hyperstimulation (COH) with clomiphene citrate (CC) combined with intrauterine insemination (IUI) is often used as treatment for ovulatory infertility which includes unexplained, male, cervical, endometriosis, and tubal infertility. Aims: To review the effectiveness of CC and IUI in ovulatory infertility. Methods: Systematic review of pertinent randomised controlled trials (RCT) using the bibliographic databases MEDLINE and EMBASE. References of selected articles identified were hand‐searched for additional relevant citations. Results: Six published RCT were included in the overall review. Meta‐analysis demonstrated a higher cycle pregnancy rate (CPR) with CC and IUI compared to timed intercourse in the natural cycle ( P < 0.001 and odds ratio = 4.6, 95% CI = 1.9–11.3). Treatment with gonadotrophins and IUI results in a higher CPR compared to CC and IUI ( P = 0.005 and odds ratio = 2.9, 95% CI = 1.3–6.2). Further RCT are required comparing CC and IUI with IUI or CC alone before one can make firm conclusions. Conclusions: Clomiphene citrate combined with IUI is more effective than timed intercourse in the natural cycle at achieving pregnancy in couples with ovulatory infertility. However, treatment with gonadotrophins and IUI is superior to CC and IUI.