To evaluate the efficacy and safety of intrauterine insemination (IUI) in
moderate to severe endometriosis patients, a systematic review and meta-analysis
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matter of debate in the literature. Systematic searches were performed in
PubMed, EMBASE, Cinahl, and The Cochrane Library from inception to September 1,
2016. Studies including moderate to severe endometriosis patients reporting
pregnancy rates after IUI were selected. The primary outcome was live birth
after IUI treatment compared to expectant management. Secondary noncomparative
outcomes were live birth and clinical pregnancy, which were presented as weighed
mean pregnancy rates. Nineteen articles (2 unclear design, 11 retrospective, 6
prospective) were included for the analysis. Our primary outcome measure was
only addressed by one study, showing an odds ratio of 1.77 (95% confidence
interval [CI], 0.86–3.63) on live birth favoring IUI versus no treatment. The
calculated weighed mean live birth and clinical pregnancy rate per patient was
20.3% (95% CI, 11.2–29.4) and 32.7% (95% CI, 21.3– 44.0), respectively. This
meta-analysis of observational data showed that IUI could be a feasible
treatment in moderate to severe endometriosis. Whether this treatment should be
structurally offered prior to in vitro fertilization needs to be investigated in
a randomized, controlled trial, including time-to-pregnancy, safety, and
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