Growing body of evidence supports intrauterine insemination as first line treatment and rejects unfounded concerns about its efficacy, risks and cost effectiveness

JBRA Assist Reprod. 2019 Jan 31;23(1):62-67. doi: 10.5935/1518-0557.20180073.

Abstract

IUI has been practiced for five decades but only three unconvincing trials attempted to demonstrate the superiority of IUI over sexual intercourse (SI). In the absence of evidence of its effectiveness, the National Institute for Clinical Excellence (NICE) recommended IVF over IUI after 2 years of unprotected SI. High-quality recent data in well-constructed studies suggest that biases against IUI procedures and in favour of IVF are invalid. It is unethical to continue to misinform patients and stakeholders. The well-constructed randomised controlled trials (RCT) show IUI procedure to be efficient, with minimal risk, and above all improved cost-effectiveness when compared to IVF for live birth. IUI as first-line treatment should be offered to most patients, while funding agencies and stakeholders need to be urgently informed of the cost-benefit in offering IUI. Fertility clinics, IVF interest groups, and regulatory bodies should amend their patient information and guidance to state that IUI should be the first line treatment and that IVF should be offered only when essential. Reappraising and promoting IUI based on evidence enhances patient autonomy, choices, and trust, while allowing the fertility industry to operate within an ethical and acceptable framework not seen as exploitative toward vulnerable patients.

Keywords: IUI; IVF/ICSI outcome; assisted reproduction; cost-effectiveness; ethics.

Publication types

  • Review

MeSH terms

  • Cost-Benefit Analysis
  • Evidence-Based Practice / statistics & numerical data*
  • Female
  • Fertilization in Vitro / adverse effects
  • Fertilization in Vitro / economics
  • Fertilization in Vitro / methods
  • Fertilization in Vitro / statistics & numerical data
  • Humans
  • Infant, Newborn
  • Infertility / epidemiology
  • Infertility / therapy*
  • Insemination, Artificial* / adverse effects
  • Insemination, Artificial* / economics
  • Insemination, Artificial* / methods
  • Insemination, Artificial* / statistics & numerical data
  • Live Birth / epidemiology
  • Male
  • Pregnancy
  • Pregnancy Rate
  • Pregnancy, Multiple / statistics & numerical data
  • Reproductive Techniques, Assisted / economics
  • Reproductive Techniques, Assisted / ethics
  • Risk Factors
  • Treatment Outcome