Evidence-based IUI in developing countries

Keywords:

Artificial insemination, assisted reproduction, human, intrauterine insemination, IUI, semen, semen quality

W. Ombelet1,2,3
1Department of Obstetrics and Gynaecology, Ziekenhuizen Oost-Limburg, Schiepse Bos, 6, 3600 Genk, Belgium.
2Faculty of Medicine and Life Sciences, Hasselt University, Agoralaan, 3590 Diepenbeek, Belgium.
Correspondence at: willem.ombelet@telenet.be

Abstract

Intrauterine inseminations (IUI) are easier to perform, less invasive and less expensive than other methods of assisted reproduction. The rationale for the use of artificial insemination is to increase gamete density at the site of fertilisation. It is generally accepted that IUI with homologous semen should be preferred as a first choice treatment above more invasive and expensive techniques of assisted reproduction in case of cervical, unexplained and moderate male factor subfertility. Scientific validation of this strategy is difficult because the literature is rather confusing.

Effectivity has been documented in controlled studies under the condition that the inseminating motile count exceeds more than 1 million motile spermatozoa. Risks and costs are minimal, provided the multiple gestation incidence can be reduced to an acceptable level and provided at least one tube is patent. Training is easy and severe complications are almost non-existing.

Reasons enough to promote the use of IUI as a valuable first line treatment for most cases of non-tubal infertility in developing countries.