What do systematic reviews say?

IVF vs expectant management

It is very uncertain whether IVF changes live birth per woman randomised compared with expectant management (very low certainty).

• In vitro fertilisation for unexplained subfertility 2023 · Cochrane Headline outcomes only
  OR 22 [2.56, 189.37]
  1 study · 51 participants
  Very low

IVF vs IUI + ovarian stimulation with gonadotropins or CC

IVF showed no clear difference in live birth rate per woman randomised compared with IUI + ovarian stimulation with gonadotropins or CC (low certainty).

• In vitro fertilisation for unexplained subfertility 2023 · Cochrane Headline outcomes only
  OR 1.19 [0.87, 1.61]
  3 studies · 731 participants
  Low

IVF vs unstimulated IUI

IVF may leads to higher live birth rate per woman randomised compared with unstimulated IUI (low certainty).

• In vitro fertilisation for unexplained subfertility 2023 · Cochrane Headline outcomes only
  OR 2.47 [1.19, 5.12]
  2 studies · 156 participants
  Low

IVF vs IUI

IVF showed no clear difference in live birth rate per couple (all cycles) compared with IUI (low certainty).

• Assisted reproductive technologies for male subfertility 2016 · Cochrane Headline outcomes only
  OR 0.77 [0.25, 2.35]
  Studies not reported
  Low
• Assisted reproductive technologies for male subfertility 2016 · Cochrane Headline outcomes only
  OR 1.03 [0.43, 2.45]
  Studies not reported
  Very low

Natural cycle IVF vs standard IVF

Natural cycle IVF showed no clear difference in live birth per woman compared with standard IVF (moderate certainty).

• Natural cycle in vitro fertilisation (IVF) for subfertile couples 2013 · Cochrane Headline outcomes only
  OR 0.68 [0.46, 1.01]
  2 studies · 425 participants
  Moderate

ART with seminal plasma vs standard ART (IVF, ICSI, and frozen embryo transfer)

ART with seminal plasma showed no clear difference in live birth compared with standard ART (IVF, ICSI, and frozen embryo transfer) (low certainty).

• Application of seminal plasma to female genital tract prior to embryo transfer in assisted reproductive technology… 2018 · Cochrane Headline outcomes only
  RR 1.1 [0.86, 1.43]
  3 studies · 948 participants
  Low

Day 3 vs Day 2 embryo transfer following IVF or ICSI

It is very uncertain whether day 3 changes live birth rate per woman compared with day 2 embryo transfer following IVF or ICSI (very low certainty).

• Day three versus day two embryo transfer following in vitro fertilization or intracytoplasmic sperm injection 2016 · Cochrane Headline outcomes only
  RR 1.05 [0.89, 1.23]
  3 studies · 1200 participants
  Very low

ART with seminal plasma vs standard ART (IVF, ICSI, and frozen embryo transfer)

ART with seminal plasma showed no clear difference in live birth or ongoing pregnancy compared with standard ART (IVF, ICSI, and frozen embryo transfer) (low certainty).

• Application of seminal plasma to female genital tract prior to embryo transfer in assisted reproductive technology… 2018 · Cochrane Headline outcomes only
  RR 1.19 [0.95, 1.49]
  4 studies · 1178 participants
  Low

Summary of findings table ‐ ICSI vs c‐IVF

Summary of findings table ‐ ICSI showed no clear difference in live Birth compared with c‐IVF (low certainty).

• Intracytoplasmic sperm injection versus conventional in vitro fertilisation in couples with males presenting with… 2023 · Cochrane Headline outcomes only
  RR 1.11 [0.94, 1.3]
  2 studies · 1124 participants
  Low

Single vs multiple embryo transfer

Single may leads to lower live birth compared with multiple embryo transfer (low certainty).

• Number of embryos for transfer following in vitro fertilisation or intra‐cytoplasmic sperm injection 2020 · Cochrane Headline outcomes only
  RR 0.67 [0.59, 0.75]
  12 studies · 1904 participants
  Low

Tubal surgery vs no surgery

The review found no eligible studies for this question.

• Surgical treatment for tubal disease in women due to undergo in vitro fertilisation 2020 · Cochrane Headline outcomes only
  no estimate extracted
  Studies not reported
  No studies found

Laparoscopic proximal tubal occlusion vs laparoscopic salpingectomy

The review found no eligible studies for this question.

• Surgical treatment for tubal disease in women due to undergo in vitro fertilisation 2020 · Cochrane Headline outcomes only
  no estimate extracted
  Studies not reported
  No studies found

Transvaginal aspiration of hydrosalpingeal fluid vs laparoscopic salpingectomy

The review found no eligible studies for this question.

• Surgical treatment for tubal disease in women due to undergo in vitro fertilisation 2020 · Cochrane Headline outcomes only
  no estimate extracted
  Studies not reported
  No studies found

Long‐term GnRH agonist therapy vs no additional therapy

It is very uncertain whether long‐term GnRH agonist therapy changes live birth rate compared with no additional therapy (very low certainty).

• Long‐term GnRH agonist therapy before in vitro fertilisation (IVF) for improving fertility outcomes in women with… 2019 · Cochrane Headline outcomes only
  RR 0.48 [0.26, 0.87]
  1 study · 147 participants
  Very low

Glucocorticoid supplementation vs placebo

Glucocorticoid supplementation showed no clear difference in live birth rate compared with placebo (low certainty).

• Glucocorticoid supplementation during ovarian stimulation for IVF or ICSI 2017 · Cochrane Headline outcomes only
  OR 1.08 [0.45, 2.58]
  2 studies · 212 participants
  Low

Recombinant luteinizing hormone (rLH) combined with recombinant follicle‐stimulating hormone (rFSH) vs rFSH alone

It is very uncertain whether recombinant luteinizing hormone (rLH) combined with recombinant… changes live birth rate compared with rFSH alone (very low certainty).

• Recombinant luteinizing hormone (rLH) and recombinant follicle stimulating hormone (rFSH) for ovarian stimulation in… 2017 · Cochrane Headline outcomes only
  OR 1.32 [0.85, 2.06]
  4 studies · 499 participants
  Very low

Monitoring ovarian stimulation by transvaginal ultrasound (TVUS) only vs monitoring with TVUS plus serum estradiol

The review found no eligible studies for this question.

• Monitoring of stimulated cycles in assisted reproduction (IVF and ICSI) 2021 · Cochrane Headline outcomes only
  no estimate extracted
  Studies not reported
  No studies found

37°C vs any lower temperature

• Temperature of embryo culture for assisted reproduction 2019 · Cochrane Headline outcomes only
  no estimate extracted
  1 study · 1 participants
  GRADE not reported

Screening hysteroscopy vs no hysteroscopy

Screening hysteroscopy may leads to higher live birth compared with no hysteroscopy (low certainty).

• Screening hysteroscopy in subfertile women and women undergoing assisted reproduction 2019 · Cochrane Headline outcomes only
  RR 1.26 [1.11, 1.43]
  6 studies · 2745 participants
  Low

In vitro maturation vs in vitro fertilisation

The review found no eligible studies for this question.

• In vitro maturation in subfertile women with polycystic ovarian syndrome undergoing assisted reproduction 2018 · Cochrane Headline outcomes only
  no estimate extracted
  Studies not reported
  No studies found