Fallopian sperm perfusion versus intrauterine insemination: a randomized controlled trial and metaanalysis of the literature

Objective: To determine whether fallopian sperm perfusion significantly improves pregnancy rates over intrauterine insemination (IUI) in infertile patients. Design: Prospective, randomized, controlled trial and metaanalysis of the literature. Setting: University-based infertility practice. Patient(s): Patients undergoing controlled ovarian stimulation were included in the prospective trial. They were <40 years of age and had no tubal obstructions, and their partners had no history of severe oligospermia. The metaanalysis was done using the patients with unexplained infertility from this study and from other randomized controlled trials found through a MEDLINE data base search. Intervention(s): After undergoing controlled ovarian stimulation, the patients were randomly assigned to receive either IUI or fallopian sperm perfusion. Main Outcome Measure(s): Clinical pregnancy rates. Result(s): Only the patients with unexplained infertility had a statistically higher pregnancy rate with fallopian sperm perfusion (odds ratio, 4.1; confidence interval, 1.1-16.4). A metaanalysis of the prospective randomized trials that provided data on patients with unexplained infertility showed a significant improvement in pregnancy rates with fallopian sperm perfusion (odds ratio, 1.9; confidence interval, 1.2-3). Conclusion(s): Fallopian sperm perfusion does not improve the chances of pregnancy in patients with infertility other than those with unexplained infertility. Fallopian sperm perfusion does significantly improve the pregnancy rates of patients with unexplained infertility who undergo controlled ovarian stimulation with gonadotropin/insemination protocols. (C) 1999 by American Society for Reproductive Medicine.