Ovarian Stimulation Strategies for Intrauterine Insemination in Couples with Unexplained Infertility - A Systematic Review and Individual Participant Data Meta-analysis

Background: Intrauterine insemination with ovarian stimulation (IUI-OS) is a first-line treatment for couples unexplained infertility. Individual participant data meta-analysis (IPD-MA) the gold standard evidence synthesis. Aim: To compare effectiveness and safety of gonadotrophin, Letrozole clomiphene citrate (CC) to explore treatment-covariate interactions important baseline characteristics in women undergoing IUI. Method: We searched electronic databases including PubMed, MEDLINE, EMBASE, Cochrane Database Systematic Reviews, Central Register Controlled Trials (CENTRAL). included randomised controlled trials (RCTs) comparing IUI-OS gonadotropins, or CC among excluded dose studies same drug. contacted authors eligible RCTs share IPD established IUI IPD-MA collaboration. The primary outcome was live birth multiple pregnancy. used one-stage approach using random effects model. Results: Six (n= 2299) provided IPD. Gonadotropins increased chance compared both (5 RCTs, 1946 women, RR 1.28, 95%CI 1.10 1.49, I2 = 25%, moderate-quality evidence) whereas there insufficient difference between (1 RCT, 599 0.77 0.58 1.03). risk pregnancy (4 1696 2.17, 1.33 3.55, 69%, low-quality 0.71, 0.33 1.56). No strong on (female age, BMI versus secondary infertility) found. Conclusion: but also Further other interventions infertility are needed.