Intrauterine insemination (IUI)

Intrauterine insemination (IUI) is an assisted conception technique that involves the deposition of a processed semen sample in the upper uterine cavity, overcoming natural barriers to sperm ascent in the female reproductive tract

• a cost-effective, noninvasive first-line therapy for selected patients with functionally normal tubes, and infertility due to a cervical factor, anovulation, moderate male factor, unexplained factors, immunological factor, and ejaculatory disorders with clinical pregnancy rates per cycle ranging from 10 to 20%
• has limited use in patients with endometriosis, severe male factor infertility, tubal factor infertility, and advanced maternal age >= 35 years (1)
• IUI may be performed with or without ovarian stimulation
  • controlled ovarian stimulation, particularly with low-dose gonadotropins, with IUI offers significant benefit in terms of pregnancy outcomes compared with natural cycle or timed intercourse, while reducing associated COH complications such as multiple pregnancies and ovarian hyperstimulation syndrome
    • a systematic review found gonadotropins improve cumulative live birth rate vs anti-oestrogens and aromatase inhibitors (2)
      • there is no convincing evidence aromatase inhibitors are superior to anti-oestrogens
      • none of the agents increased the multiple pregnancy rate

NICE state with respect to intrauterine insemination (3)

• for people with unexplained infertility, mild endometriosis or 'mild male factor infertility', who are having regular unprotected sexual intercourse:
  • do not routinely offer intrauterine insemination, either with or without ovarian stimulation (exceptional circumstances include, for example, when people have social, cultural or religious objections to IVF) advise them to try to conceive for a total of 2 years (this can include up to 1 year before their fertility investigations) before IVF will be considered

Notes (1):

• transcriptome of spermatozoa used in homologous IUI reveals profound differences between expression profiles of sperm samples that impregnate successfully and those that do not
  • these differences might improve the predictive power of sperm evaluation to estimate IUI success by complementing the basic sperm analysis

Reference:

• Allahbadia GN. Intrauterine Insemination: Fundamentals Revisited. J Obstet Gynaecol India. 2017;67(6):385-392. doi:10.1007/s13224-017-1060-x
• Cantineau AEP, Rutten AGH, Cohlen BJ. Agents for ovarian stimulation for intrauterine insemination (IUI) in ovulatory women with infertility. Cochrane Database of Systematic Reviews 2021, Issue 11. Art. No.: CD005356
• NICE (September 2017).Fertility - Assessment and treatment for people with fertility problems