The effect of slow release insemination on pregnancy rates: report of two randomized controlled pilot studies and meta-analysis

Arch Gynecol Obstet. 2017 Apr;295(4):1025-1032. doi: 10.1007/s00404-017-4290-3. Epub 2017 Feb 14.


Purpose: A modified application technique of intrauterine insemination (IUI) is slow release insemination (SRI), first described by Muharib et al. (Hum Reprod 7(2):227-229, 1992), who postulated higher pregnancy rates with a slow release of spermatozoa for 3 h.

Methods: To investigate this approach, two randomized controlled, cross-over pilot studies were performed from 2004 to 2006 in Israel and Germany to compare SRI with the standard bolus IUI. We aimed to present the results and perform a meta-analysis on available data for SRI. Univariate comparisons of pregnancy rates were performed using one-tailed z tests for method superiority. For meta-analysis, a fixed-effect Mantel-Haentzel weighted average of relative risk was performed.

Results: Fifty treatment cycles (IUI: n = 25, SRI: n = 25) were performed in Germany, achieving four pregnancies (IUI: 4%, SRI: 12%, p > 0.05). Thirty-nine treatment cycles (IUI: n = 19, SRI: n = 20) were performed in Israel achieving six pregnancies (IUI: 10.5%, SRI: 20%; p > 0.05). Meta-analysis of all eligible studies for SRI (n = 3) revealed a combined relative risk for pregnancy after SRI of 2.64 (95% CI 1.04-6.74), p = 0.02).

Conclusions: In conclusion, these results lend support to the hypothesis that the pregnancy rate might be improved by SRI compared to the standard bolus technique.

Keywords: Infertility; Intrauterine insemination; Outcome; Pregnancy rate; Slow release insemination.

Publication types

  • Meta-Analysis

MeSH terms

  • Adult
  • Cross-Over Studies
  • Female
  • Fertilization in Vitro
  • Germany
  • Humans
  • Insemination, Artificial / instrumentation
  • Insemination, Artificial / methods*
  • Israel
  • Male
  • Pilot Projects
  • Pregnancy
  • Pregnancy Rate*
  • Random Allocation
  • Spermatozoa
  • Time Factors