人工受精後不需要臥床休息15分鐘

Hum Reprod. 2017 Nov 1;32(11):2218-2224. doi: 10.1093/humrep/dex302.

Immobilization or mobilization after IUI: an RCT.

van Rijswijk J1, Caanen MR1, Mijatovic V1, Vergouw CG1, van de Ven PM2, Lambalk CB1, Schats R1.

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Abstract

STUDY QUESTION:

Does 15 min of immobilization after IUI improve pregnancy rates?

SUMMARY ANSWER:

Immobilization for 15 min after IUI does not improve pregnancy rates.

WHAT IS KNOWN ALREADY:

Prior RCTs report a beneficial effect of supine immobilization for 15 min following IUI compared to immediate mobilization, however, these studies can be criticized. Given the importance for the logistics in daily practice and the lack of biological plausibility we planned a replication study prior to potential implementation of this procedure.

STUDY DESIGN, SIZE, DURATION:

A single centre RCT, based in an academic setting in the Netherlands, was performed. Participants were randomly assigned for 15 min of supine immobilization following IUI for a maximum of six cycles compared to the standard procedure of immediate mobilization following IUI. Participants and caregivers were not blinded to group assignment. An independent researcher used computer-generated tables to allocate treatments. Stratification occurred to the indication of IUI (unexplained or mild male subfertility). Revelation of allocation took place just before the insemination by the caregiver. The primary outcome was ongoing pregnancy rate per couple.

PARTICIPANTS/MATERIALS, SETTING, METHODS:

A total of 498 couples diagnosed with unexplained or mild male subfertility and an indication for treatment with IUI were approached and randomized in the study, of which 244 participants were assigned to 15 min of supine immobilization and 254 participants to immediate mobilization.

MAIN RESULTS AND THE ROLE OF CHANCE:

Participant characteristics were comparable between the groups, and 236 participants were analysed in the immobilization group, versus 245 in the mobilization group. The ongoing pregnancy rate per couple was not found to be superior in the immobilization group (one-sided P-value = 0.97) with 76/236 ongoing pregnancies (32.2%) being accomplished in the immobilization and 98/245 ongoing pregnancies (40.0%) in the immediate mobilization group (relative risk 0.81; 95% CI [0.63, 1.02], risk difference: -7.8%, 95% CI [-16.4%, 0.8%]). No difference was found in miscarriage rate, multiple gestation rate, live birth rate and time to pregnancy between the groups.