Infertility – Related resources

Cochrane reviews

• Antioxidants might not be effective for improving birth rate in subfertile women compared with placebo or no treatment, but the evidence is limited .
Peri-implantation low molecular weight heparin in assisted reproduction treatment cycles might possibly improve the live birth rate in women undergoing assisted reproduction compared to placebo or no treatment .
• Women who have had ovulation induction for infertility might not have an increased risk for ovarian cancer .
• Antioxidant supplementation in subfertile males may be effective for improving live birth and pregnancy rate for subfertile couples undergoing assisted reproduction cycles .
• Different techniques of timing may be similarly effective for intrauterine insemination in subfertile couples .
• There is insufficient evidence to recommend any one particular protocol for endometrial preparation over another with regard to pregnancy rates after embryo transfers .
• Double intrauterine insemination in stimulated cycles appears to result in higher pregnancy rate compared to single intrauterine insemination in the treatment of subfertile couples with husband semen .
• The use of single embryo transfer in a fresh in vitro fertilisation cycle results in lower livebirth rates with much lower rates of multiple pregnancy than double embryo transfer, but subsequent transfer of a frozen embryo appear to provide outcomes that are comparable with one fresh cycle of double embryo transfer .
• Metformin treatment before and during assisted reproductive techniques (IVF or ICSI) seems not to be effective in increasing live birth rate in infertile women with polycystic ovary syndrome, however it may reduce the risk of ovarian hyperstimulation syndrome .
• Urinary hCG as an ovulation trigger in anovulatory women treated with clomiphene citrate compared with no treatment may not increase the live birth rate .
• Fallopian tube sperm perfusion may be as effective as intrauterine insemination for couples with unexplained subfertility .
• Most children born after IVF may be healthy although the risks of twin pregnancies, premature birth and low birth weight are elevated . Luteal phase support with hCG or progesterone after assisted reproduction results in an increased pregnancy rate. hCG does not provide better results than progesterone, and is associated with a greater risk of ovarian hyperstimulation syndrome when used with GnRHa .
• GnRH antagonist protocol appears to be effective forassisted conception, with a large reduction in ovarian hyperstimulation syndrome and no difference in live-birth rates compared to the GnRH agonist long protocol .
• Tubal flushing with oil-soluble contrast media appears to be effective in increasing the odds of pregnancy and live birth versus no intervention in women with infertility .
• Intrauterine insemination may not be an effective treatment for cervical hostility (poor-quality or insufficient mucus) as compared to timed intercourse or expectant management .
• Pregnancy rates may increase with the use of gonadotrophins for male infertility .
• Gonadotrophins appear to be the most effective drugs when intrauterine insemination (IUI) is combined with ovarian hyperstimulation .
• There is insufficient evidence on the effectiveness of intra-uterine insemination as compared with timed intercourse for male subfertility .
• Pain relief is probably not effective in reducing pain during or immediately after HSG, but it may cause pain reduction 30 minutes after the procedure .
• Co-administration of recombinant luteinizing hormone (rLH) to rFSH in GnRH agonist down-regulated women does not result in more live births than controlled ovarian hyperstimulation with rFSH alone .
• Laparoscopic salpingectomy increases the odds of pregnancy in women with hydrosalpinges who are due to undergo IVF (NNT between 7 and 8 to gain one additional live birth) .
• Ovulation suppression is not effective in subfertile women with endometriosis who wish to conceive .
• Intra-venous hydroxyethyl starch is effective in prevention of severe OHSS in high-risk women compared to placebo .
• Intra-uterine insemination increases live birth rates and pregnancy rates compared to cervical insemination in stimulated cycles using cryopreserved sperm for donor insemination .
• Low-dose aspirin is probably not effective for increasing live birth rate, or clinical pregnancy rate in women undergoing in vitro fertilisation .
• There is insufficient evidence for conclusion concerning the relative advantages or disadvantages of the different surgical techniques used for the treatment of tubal infertility .

Other evidence summaries

• Women who have had ovulation induction for infertility might not have an increased risk for ovarian cancer .
• The discriminative capacity of Chlamydia antibody titers by means of ELISA, microimmunofluorescence or immunofluorescence in the diagnosis of any tubal pathology may be comparable to that of hysterosalpingography .
• The discriminative ability of the post-coital test may be poor .
• Performing SPA may be insufficient for selecting patients for treatment with in vitro fertilization embryo transfer .

Literature

Clinical practice reviews

• De Vos M, Devroey P, Fauser BC. Primary ovarian insufficiency. Lancet 2010 Sep 11;376(9744):911-21.
• Sutcliffe AG, Ludwig M. Outcome of assisted reproduction. Lancet 2007 Jul 28;370(9584):351-9
• Balen AH, Rutherford AJ. Management of infertility. BMJ 2007 Sep 22;335(7620):608-11
• Balen AH, Rutherford AJ. Managing anovulatory infertility and polycystic ovary syndrome. BMJ 2007 Sep 29;335(7621):663-6