Efficacy and Safety of Misoprostol for Intrauterine Insemination: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

SONG rong ¹ ,  CAI xia ¹ , WU Taixiang ²

1. The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China;2. Chinese Evidence-Based Medicine/Chinese Cochrane Centre, West China Hospital, Sichuan University, Chengdu 610041, China;

Corresponding author：

CAI xia, Email: CaiXia5512@126.com

Keywords：

Intrauterine insemination; Misoprostol; Systematic review

DOI：

10.7507/1672-2531.20100547

Video：

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Objectives　 To assess the efficacy and safety of misoprostol for intrauterine insemination (IUI).
Methods　 The Cochrane Library, EMbase, MEDLINE, SCIENCE Direct Database, CBM, Wangfang Data and CNKI were searched for collecting randomized controlled trials or controlled clinical trials published before October, 2009. Statistical analysis was performed with RevMan 5.0 software.
Results　 Five Randomized controlled trials (RCTs) were included according to the inclusion and exclusion criteria at last. Five RCTs involving 546 participants and 1 133 cycles are included. Meta-analysis showed that, compared with placebo group, 400 μg misoprostol could increase pregnancy rate of IUI (RR=1.95, 95%CI 1.19 to 3.19); compared with 200 μg misoprostol group, 400 μg misoprostol also has higher incidence rate of abdominal pain (RR=3.13, 95%CI 1.86 to 5.26) and vaginal bleeding (RR=5.25, 95%CI 2.08 to 13.21).
Conclusions　 Because of the limited studies, recommendation of using misoprostol in IUI cycles is not fully convinced, which has to be further proved by more randomized controlled trials in large sample with high quality.

Citation： SONG rong,CAI xia,WU Taixiang. Efficacy and Safety of Misoprostol for Intrauterine Insemination: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2010, 10(9): 1072-1078. doi: 10.7507/1672-2531.20100547 Copy

1.	Shea OR, Shah IH. Chapter 08 Conclusion //Sidney Moore. Infecundity, Infertility, and Childlessness in Developing Countries. DHS Comparative Reports No. 9. Calverton, Maryland, USA: ORC Macro and the World Health Organization, 2004: 53-54.
2.	Safarinejad MR. Infertility among couples in a population-based study in Iran: prevalence and associated risk factors. Int J Androl, 2008, 31(3): 303-314.
3.	Larsen U. Research on infertility: which definition should we use. Fertil Steril, 2005, 83(4): 846-852.
4.	Boivin J, Bunting L, Collins JA, et al. International estimates of infertility prevalence and treatment-seeking: potential need and demand for infertility medical care. Hum Reprod, 2007, 22(6): 1506-1512.
5.	高峻, 高尔生. 中国育龄妇女不孕率及其影响因素分析. 中国卫生统, 2005, 22(2): 26-28.
6.	Moslemizadeh N, Moghadam TG, Peyvandi S. Evaluation of vaginal misoprostol effect on pregnancy rate after intrauterine insemination. Pak J Biol Sci, 2009, 12(1): 64-68.
7.	Billiet K, Dhont M, Vervaet C, et al. A multi-center prospective, randomized, double-blind trial studying the effect of misoprostol on the outcome of intrauterine insemination. Gynecol Obstet Invest, 2008, 66: 145-151.
8.	侯翠, 王文军, 张清学, 等. 1136周期宫腔内夫精人工授精临床因素的分析. 中国妇幼保健, 2009, 24(11): 1521-1523.
9.	Janssen MJ, Cohlen BJ, Cantineau AEP. Timing modalities for intrauterine insemination in subfertile couples(Protocol). Cochrane Database of Systematic Reviews 2008, Issue 1. Art. No.: CD006942. DOI: 10.1002/14651858.CD006942.
10.	Agarwal S, MittalIndian S. A randomised prospective trial of intrauterine insemination versus timed intercourse in superovulated cycles with clomiphene. Indian J Med Res, 2004, 120: 519-522.
11.	Ensieh Sh, Nejad T, Abediasl Z, et al. Comparison of the efficacy of the aromatase inhibitor letrozole and clomiphen citrate gonadotropins in controlled ovarian hyperstimulation: a prospective, simply randomized, clinical trial. J Assist Reprod Genet, 2008, 25: 187-190.
12.	Erdem A, Erdem M, Atmaca S, et al. Factors affecting live birth rate in intrauterine insemination cycles with recombinant gonadotrophin stimulation. Reprod Biomed Online, 2008, 7(2): 99-206.
13.	van Rumste MME, Custers IM, van der Veen F, et al. The influence of the number of follicles on pregnancy rates in intrauterine insemination with ovarian stimulation: a meta-analysis. Hum Reprod Update, 2008, 14(6): pp 563-570.
14.	Snick HK, Collins JA, Evers JLH, et al. What is the most valid comparison treatment in trials of intrauterine insemination, timed or uninfluenced intercourse? A systematic review and meta-analysis of indirect evidence. Hum Reprod, 2008, 23(10): 2239-2245.
15.	The ESHRE Capri Workshop Group. Intrauterine insemination. Hum Reprod Update, 2009, 15(3): 265-277.
16.	Cantineau AEP, Heineman MJ, Cohlen BJ. Single versus double intrauterine insemination in stimulated cycles for subfertile couples: a systematic review based on a Cochrane review. Hum Reprod, 2003, 18(5): 941-946.
17.	Abou-Setta AM, Mansour RT, Al-Inany HG. Intrauterine insemination catheters for assisted reproduction: a systematic review and meta-analysis. Hum Reprod, 2006, 21(8): 1961-1967.
18.	Brown SE, Toner JP, Schnorr JA, et al. Vaginal misoprostol enhances intrauterine insemination. Hum Reprod, 2001, 16(1): 96-101.
19.	Barroso G, Karchmer S, Castelazo E, et al. A prospective randomized trial of the impact of misoprostol (PgE1) on pregnancy rate after intrauterine insemination (IUI) therapy: a preliminary report. Ginecol Obstet Mex, 2001, 69: 346-350.
20.	Toner J, de Ziegler D, Brown S, et al. High rates of cramping with misoprostol administration for intrauterine insemination. Hum Reprod, 2001, 16(5): 1051-1052.
21.	Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions. Version 5.0.1 .
22.	吴泰相, 刘关键. 隐蔽分组（分配隐藏）和盲法的概念, 实施与报告. 中国循证医学杂志, 2007, 7(3): 222-224.
23.	Cantineau AE, Cohlen BJ, Dutch IUI Study Group. The prevalence and influence of luteinizing hormone surges in stimulated cycles combined with intrauterine insemination during a prospective cohort study. Fertil Steril, 2007, 88: 107-112.

1. Shea OR, Shah IH. Chapter 08 Conclusion //Sidney Moore. Infecundity, Infertility, and Childlessness in Developing Countries. DHS Comparative Reports No. 9. Calverton, Maryland, USA: ORC Macro and the World Health Organization, 2004: 53-54.
2. Safarinejad MR. Infertility among couples in a population-based study in Iran: prevalence and associated risk factors. Int J Androl, 2008, 31(3): 303-314.
3. Larsen U. Research on infertility: which definition should we use. Fertil Steril, 2005, 83(4): 846-852.
4. Boivin J, Bunting L, Collins JA, et al. International estimates of infertility prevalence and treatment-seeking: potential need and demand for infertility medical care. Hum Reprod, 2007, 22(6): 1506-1512.
5. 高峻, 高尔生. 中国育龄妇女不孕率及其影响因素分析. 中国卫生统, 2005, 22(2): 26-28.
6. Moslemizadeh N, Moghadam TG, Peyvandi S. Evaluation of vaginal misoprostol effect on pregnancy rate after intrauterine insemination. Pak J Biol Sci, 2009, 12(1): 64-68.
7. Billiet K, Dhont M, Vervaet C, et al. A multi-center prospective, randomized, double-blind trial studying the effect of misoprostol on the outcome of intrauterine insemination. Gynecol Obstet Invest, 2008, 66: 145-151.
8. 侯翠, 王文军, 张清学, 等. 1136周期宫腔内夫精人工授精临床因素的分析. 中国妇幼保健, 2009, 24(11): 1521-1523.
9. Janssen MJ, Cohlen BJ, Cantineau AEP. Timing modalities for intrauterine insemination in subfertile couples(Protocol). Cochrane Database of Systematic Reviews 2008, Issue 1. Art. No.: CD006942. DOI: 10.1002/14651858.CD006942.
10. Agarwal S, MittalIndian S. A randomised prospective trial of intrauterine insemination versus timed intercourse in superovulated cycles with clomiphene. Indian J Med Res, 2004, 120: 519-522.
11. Ensieh Sh, Nejad T, Abediasl Z, et al. Comparison of the efficacy of the aromatase inhibitor letrozole and clomiphen citrate gonadotropins in controlled ovarian hyperstimulation: a prospective, simply randomized, clinical trial. J Assist Reprod Genet, 2008, 25: 187-190.
12. Erdem A, Erdem M, Atmaca S, et al. Factors affecting live birth rate in intrauterine insemination cycles with recombinant gonadotrophin stimulation. Reprod Biomed Online, 2008, 7(2): 99-206.
13. van Rumste MME, Custers IM, van der Veen F, et al. The influence of the number of follicles on pregnancy rates in intrauterine insemination with ovarian stimulation: a meta-analysis. Hum Reprod Update, 2008, 14(6): pp 563-570.
14. Snick HK, Collins JA, Evers JLH, et al. What is the most valid comparison treatment in trials of intrauterine insemination, timed or uninfluenced intercourse? A systematic review and meta-analysis of indirect evidence. Hum Reprod, 2008, 23(10): 2239-2245.
15. The ESHRE Capri Workshop Group. Intrauterine insemination. Hum Reprod Update, 2009, 15(3): 265-277.
16. Cantineau AEP, Heineman MJ, Cohlen BJ. Single versus double intrauterine insemination in stimulated cycles for subfertile couples: a systematic review based on a Cochrane review. Hum Reprod, 2003, 18(5): 941-946.
17. Abou-Setta AM, Mansour RT, Al-Inany HG. Intrauterine insemination catheters for assisted reproduction: a systematic review and meta-analysis. Hum Reprod, 2006, 21(8): 1961-1967.
18. Brown SE, Toner JP, Schnorr JA, et al. Vaginal misoprostol enhances intrauterine insemination. Hum Reprod, 2001, 16(1): 96-101.
19. Barroso G, Karchmer S, Castelazo E, et al. A prospective randomized trial of the impact of misoprostol (PgE1) on pregnancy rate after intrauterine insemination (IUI) therapy: a preliminary report. Ginecol Obstet Mex, 2001, 69: 346-350.
20. Toner J, de Ziegler D, Brown S, et al. High rates of cramping with misoprostol administration for intrauterine insemination. Hum Reprod, 2001, 16(5): 1051-1052.
21. Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions. Version 5.0.1 .
22. 吴泰相, 刘关键. 隐蔽分组（分配隐藏）和盲法的概念, 实施与报告. 中国循证医学杂志, 2007, 7(3): 222-224.
23. Cantineau AE, Cohlen BJ, Dutch IUI Study Group. The prevalence and influence of luteinizing hormone surges in stimulated cycles combined with intrauterine insemination during a prospective cohort study. Fertil Steril, 2007, 88: 107-112.

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Efficacy and Safety of Misoprostol for Intrauterine Insemination: A Systematic Review

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