To inseminate or not, that is the question. A reflection of existing evidence

Keywords:

IUI, IVF, cost-effectiveness, indications

B. J. COHLEN

Fertility Center Isala, Isala Clinics Zwolle, PO BOX 10400, 8000 GK Zwolle, The Netherlands.

Correspondence at: b.cohlen@ziggo.nl

Abstract

A short review stating levels of evidence is given regarding the indications for IUI and the cost-effectiveness of (stimulated) IUI compared with that of IVF. It is concluded that IUI in natural cycles should be applied in couples with cervical hostility, might be applied in couples with a moderate semen factor and should not be applied in couples with unexplained subfertility. Intrauterine insemination in cycles with MOH should be applied in couples with unexplained subfertility and might be applied in couples with a mild semen factor. Furthermore there still seems to be a place for IUI in natural and stimulated cycles comparing cost-effectiveness with IVF. However, cumulative pregnancy rates after mild IVF combined with single transfer of frozen and thawed embryos is increasing and therefore future RCTs are mandatory comparing modern IVF with IUI.