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 for any indication? Summary answer Significantly higher LBR/OPR was noted for gonadotrophins versus oral agents. Clomiphene+estrogen and gonadotrophins+letrozole demonstrated significantly higher OPR/LBR compared to no stimulation/stimulation with oral agents alone. What is known already Stimulated IUI is one of the most widespread fertility treatments offered for various indications. The rationale of stimulated IUI cycles follows the concept that more available oocytes for fertilisation would lead to increase chances of conception. Although several small pairwise comparisons are reported between different stimulation agents, there is no overall comparison using a network meta-analysis. Optimising the ovarian stimulation is an important step towards evidence-based guidelines. There is a cost- effect balance which should be kept in mind between achieving multi follicular growth to boost success rates and keeping the intervention safe in relation to multiple pregnancies. Study design, size, duration This review has been conducted in accordance with PRISMA guidelines and has been registered in PROSPERO (CRD42022300857). A computerized literature search was performed using EMBASE, MEDLINE and CINAHL as well as the Cochrane Central register of trials from database inception to May 2022. Randomized controlled trials (RCTs) were included. A random effects network meta-analysis within a frequentist setting was performed for the primary outcome live birth rate/ongoing pregnancy rate (LBR)/(OPR) and for multiple pregnancy rate. Participants/materials, setting, methods Couples/single women undergoing one or more cycles of stimulated IUI for various indications using partner’s or donor sperm were included. The effect sizes of the outcome were estimated as odds ratio (ORs) and presented along with their 95% confidence interval (CIs). We used network plots to illustrate head-to-head comparisons. The superiority of the interventions was assessed; we calculated the probability of being the best, the mean rank, and the surface under cumulative ranking (SUCRA). Main results and the role of chance 57 RCTs were identified comparing stimulation protocols. These included oral agents (clomiphene, letrozole, anastrozole, tamoxifene, estrogen), injectable hormones (FSH, hMG +/- GnRH agonists and GnRH antagonists), alon