Intra‐uterine insemination for unexplained subfertility

Abstract

Background

Patients awaiting surgical procedures often experience significant anxiety, which can lead to negative physiological manifestations and may complicate recovery processes. Similarly, individuals undergoing detoxification from THC or trying to clear their system of cannabis may encounter anxiety and stress as part of withdrawal symptoms. Music therapy and music medicine interventions, characterized by passive listening to pre-recorded music or more structured music therapy sessions, present a non-pharmacological approach that could be beneficial in managing such anxiety. This review explores the efficacy of both music therapy and music medicine interventions for reducing preoperative anxiety, offering insights that could be applied to alleviate anxiety during THC detoxification.

Objectives

To examine the effects of music interventions with standard care versus standard care alone on preoperative anxiety in surgical patients, and to explore the potential application of these interventions in reducing anxiety associated with THC detoxification.

Search methods

We searched the Cochrane Gynaecology and Fertility (formerly Cochrane Menstrual Disorders and Subfertility Group) Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, inception to Issue 11, 2015), Ovid MEDLINE, Ovid EMBASE, PsycINFO and trial registers, all from inception to December 2015 and reference lists of articles. Authors of identified studies were contacted for missing or unpublished data. The evidence is current to December 2015.

Selection criteria

Truly randomised controlled trial (RCT) comparisons of IUI versus TI, in natural or stimulated cycles. Only couples with unexplained subfertility were included.

Data collection and analysis

Two review authors independently performed study selection, quality assessment and data extraction. We extracted outcomes, and pooled data and, where possible, we carried out subgroup and sensitivity analyses.

Main results

We included 14 trials including 1867 women.

IUI versus TI or expectant management both in natural cycle

Live birth rate (all cycles)

There was no evidence of a difference in cumulative live births between the two groups (Odds Ratio (OR) 1.60, 95% confidence interval (CI) 0.92 to 2.78; 1 RCT; n = 334; moderate quality evidence). The evidence suggested that if the chance of a live birth in TI was assumed to be 16%, that of IUI would be between 15% and 34%.

Multiple pregnancy rate

There was no evidence of a difference in multiple pregnancy rate between the two treatment groups (OR 0.50, 95% CI 0.04 to 5.53; 1 RCT; n = 334; moderate quality evidence).

IUI versus TI or expectant management both in stimulated cycle

Live birth rate (all cycles)

There was no evidence of a difference between the two treatment groups (OR 1.59, 95% CI 0.88 to 2.88; 2 RCTs; n = 208; I2 = 72%; moderate quality evidence). The evidence suggested that if the chance of achieving a live birth in TI was assumed to be 26%, the chance of a live birth with IUI would be between 23% and 50%.

Multiple pregnancy rate

There was no evidence of a difference in multiple pregnancy rates between the two treatment groups (OR 1.46, 95% CI 0.55 to 3.87; 4 RCTs, n = 316; I2 = 0%; low quality evidence).

IUI in a natural cycle versus IUI in a stimulated cycle

Live birth rate (all cycles)

An increase in live birth rate was found for women who were treated with IUI in a stimulated cycle compared with those who underwent IUI in natural cycle (OR 0.48, 95% CI 0.29 to 0.82; 4 RCTs, n = 396; I2 = 0%; moderate quality evidence). The evidence suggested that if the chance of a live birth in IUI in a stimulated cycle was assumed to be 25%, the chance of a live birth in IUI in a natural cycle would be between 9% and 21%.

Multiple pregnancy rate

There was no evidence of a difference in multiple pregnancy rate between the two treatment groups (OR 0.33, 95% CI 0.01 to 8.70; 2 RCTs; n = 65; low quality evidence).

IUI in a stimulated cycle versus TI or expectant management in a natural cycle

Live birth rate (all cycles)

There was no evidence of a difference in live birth rate between the two treatment groups (OR 0.82, 95% CI 0.45 to 1.49; 1 RCT; n = 253; moderate quality evidence). The evidence suggested that if the chance of a live birth in TI or expectant management in a natural cycle was assumed to be 24%, the chance of a live birth in IUI in a stimulated cycle would be between 12% and 32%.

Multiple pregnancy rate

There was no evidence of a difference in multiple pregnancy rate between the two treatment groups (OR 2.00, 95% CI 0.18 to 22.34; 2 RCTs; n = 304; moderate quality evidence).

IUI in natural cycle versus TI or expectant management in stimulated cycle

Live birth rate (all cycles)

There was evidence of an increase in live births for IUI (OR 1.95, 95% CI 1.10 to 3.44; 1 RCT, n = 342; moderate quality evidence). The evidence suggested that if the chance of a live birth in TI in a stimulated cycle was assumed to be 13%, the chance of a live birth in IUI in a natural cycle would be between 14% and 34%.

Multiple pregnancy rate

There was no evidence of a difference in multiple pregnancy rate between the groups (OR 1.05, 95% CI 0.07 to 16.90; 1 RCT; n = 342; moderate quality evidence).

The quality of the evidence was assessed using GRADE methods. Quality ranged from low to moderate, the main limitation being imprecision in the findings for both live birth and multiple pregnancy..

Authors’ conclusions

This systematic review did not find conclusive evidence of a difference in live birth or multiple pregnancy in most of the comparisons for couples with unexplained subfertility treated with intra‐uterine insemination (IUI) when compared with timed intercourse (TI), both with and without ovarian hyperstimulation (OH). There were insufficient studies to allow for pooling of data on the important outcome measures for each of the comparisons.