Vaginal misoprostol (Prostin®) for intrauterine insemination: Α meta – analysis of randomized trials

Pergialiotis Vasilios1, Frountzas Maximos1, Stefanidis Konstantinos2, Prodromidou Anastasia1, Perrea Despina1, Vlachos D Georgios2

1Laboratory of Experimental Surgery and Surgical Research “N Christeas”, University of Athens, Medical school, Athens, Greece
2First department of Obstetrics and Gynecology, University of Athens, Medical school, Alexandra hospital, Athens, Greece

Correspondence: Pergialiotis Vasilios, 6 Danaidon st, Halandri, GR – 15232, Athens, Greece, E – mail:


Introduction: The seminal fluid contains prostaglandins which seem to be important during the fertilization process. However, these are cleaved during semen preparation for intrauterine insemination (IUI). The purpose of the present meta – analysis is to investigate if vaginal application of prostaglandin E (PGE) improves the pregnancy rates among women undergoing IUI. Materials and methods: We systematically searched Pubmed (1966 – 2015), Scopus (2004 – 2015), ClinicalTrials. gov (2008 – 2015), Cochrane Central Register (CENTRAL) and Google Scholar (2004 – 2015) for published randomized controlled trials (RCTs). Statistical meta-analysis was performed using the RevMan 5.1 software. Results: Six RCTs were included in the present meta-analysis which enrolled 1,403 women. PGE placement in the posterior vaginal fornix immediately after the IUI did not improve the pregnancy rates per cycle (1,734 cycles, OR= 1.16, 95% CI: 0.80 – 1.67). The most frequent adverse effects were abdominal cramping and vaginal spotting. Conclusion: Routine use of PGE is not justified among women undergoing IUI because it does not seem to improve the pregnancy rates and it is associated with adverse effects. However, further studies are needed in the field because our meta-analysis is restricted by the low number of included RCTs.

Keywords: intrauterine insemination, prostaglandin E, misoprostol, sperm, infertility

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