P-025 Optimising stimulated IUI; a systematic review and network meta-analysis

Abstract Study question What is the effectiveness and safety of various follicular phase ovarian stimulation protocols for intrauterine insemination (IUI) performed any indication? Summary answer Significantly higher LBR/OPR was noted gonadotrophins versus oral agents. Clomiphene+estrogen gonadotrophins+letrozole demonstrated significantly OPR/LBR compared to no stimulation/stimulation with agents alone. known already Stimulated IUI one most widespread fertility treatments offered indications. The rationale stimulated cycles follows concept that more available oocytes fertilisation would lead increase chances conception. Although several small pairwise comparisons are reported between different agents, there overall comparison using a network meta-analysis. Optimising an important step towards evidence-based guidelines. There cost- effect balance which should be kept in mind achieving multi growth boost success rates keeping intervention safe relation multiple pregnancies. design, size, duration This review has been conducted accordance PRISMA guidelines registered PROSPERO (CRD42022300857). A computerized literature search EMBASE, MEDLINE CINAHL as well Cochrane Central register trials from database inception May 2022. Randomized controlled (RCTs) were included. random effects meta-analysis within frequentist setting primary outcome live birth rate/ongoing pregnancy rate (LBR)/(OPR) rate. Participants/materials, setting, methods Couples/single women undergoing or indications partner’s donor sperm sizes estimated odds ratio (ORs) presented along their 95% confidence interval (CIs). We used plots illustrate head-to-head comparisons. superiority interventions assessed; we calculated probability being best, mean rank, surface under cumulative ranking (SUCRA). Main results role chance 57 RCTs identified comparing protocols. These included (clomiphene, letrozole, anastrozole, tamoxifene, estrogen), injectable hormones (FSH, hMG +/- GnRH agonists antagonists), alone combination, other agent (s). randomized 11341 participants across 14 countries 1994 2020. Fourteen multi-centre 43 (75%) single centre. Comparisons assessed order identify combination superior maximum without compromising safety. clomiphene had showed (OR: 1.58, CI 1.24-2.02). No aromatase inhibitors lower + estrogen (OR stimulation: 0.29, 0.10-0.83; OR clomiphene: 0.27, 0.10-0.69; letrozole 0.30, 0.11-0.83) 0.22, 0.06-0.82; 0.21, 0.06-0.73; 0.23, 0.06-0.85).The each strategy terms risk pregnancy. Limitations, reasons caution Comparing challenging view heterogeneity amongst trials. Different add-ons could benefit specific patient groups but based on data, recommendations cannot proposed according subfertility diagnosis. Various add-ons, protocol variations preparation techniques also affect outcomes. Wider implications findings Stimulation strategies aiming Strict cancellation criteria monitoring required. Cost effectiveness, ease administration, cycle couple’s preferences taken into consideration. Future take account background characteristics. Trial registration number not applicable