From the Guidelines
Intrauterine Insemination (IUI) is a viable fertility treatment option with benefits including a relatively simple procedure, lower cost, and effectiveness for certain fertility issues, but it carries risks such as multiple pregnancy and ovarian hyperstimulation syndrome (OHSS), and therefore, should be approached with caution and careful consideration of individual factors. The benefits of IUI include its minimal discomfort and effectiveness for mild male factor infertility, cervical factor infertility, and unexplained infertility 1. IUI may be combined with fertility medications like Clomiphene citrate or tamoxifen, which are acceptable alternatives to low dose gonadotrophins for low multiple birth rates and lower costs, although at a lower live birth rate 1. However, IUI carries risks including multiple pregnancy, which can be mitigated by using regimens with 75 IU or lower of gonadotrophins, as higher doses have similar pregnancy rates but increase multiple pregnancy rates 1.
Some key points to consider when evaluating the risks and benefits of IUI include:
- The use of gonadotrophins in IUI should be limited to regimens with 75 IU or lower to minimize the risk of multiple pregnancy 1
- Clomiphene citrate or tamoxifen are acceptable alternatives to low dose gonadotrophins for low multiple birth rates and lower costs, although at a lower live birth rate 1
- The addition of GnRH agonist to gonadotrophins in IUI-OS is not recommended due to the increased risk of multiple pregnancy and costs without a significant increase in pregnancy rates 1
- Measures to prevent multiple pregnancies can be divided into primary and secondary measures, including attempting to prevent the growth of more than two to three dominant follicles and applying the appropriate drug and doses 1
The most important consideration in IUI is to minimize the risk of multiple pregnancy, which can be achieved by careful monitoring and adjustment of medication regimens, and therefore, it is essential to weigh the potential benefits and risks of IUI carefully and consider individual factors, such as age, fertility issues, and medical history, before making a decision 1.
From the Research
Risks of Intrauterine Insemination (IUI)
- Multiple pregnancy rates are increased with the use of ovarian hyperstimulation (OH) in combination with IUI 2, 3, 4
- Ovarian hyperstimulation syndrome (OHSS) is a potential risk of OH 2, 3, 5
- Miscarriage rate and ectopic pregnancy are potential risks, but there is insufficient data to investigate the impact of IUI with or without OH on these outcomes 2, 3
- The risk of infection and other complications is low, but can occur with any invasive medical procedure
Benefits of Intrauterine Insemination (IUI)
- IUI is a cost-effective and non-invasive 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 6
- IUI can improve the chances of pregnancy, especially when combined with ovarian stimulation 6, 2, 4
- IUI is less invasive and expensive than in vitro fertilization (IVF) 2, 4, 5
- IUI can be performed with or without ovarian stimulation, and controlled ovarian stimulation can offer significant benefits in terms of pregnancy outcomes 6
Effectiveness of IUI
- The effectiveness of IUI treatment is not consistent, and the role of IUI and IVF treatment in practice protocols has not been clarified 4
- Stimulated IUI is ineffective in male infertility, and the effect on other diagnoses is small 4
- Pregnancy rates with IUI average 7-12% per cycle, depending on the protocol used 6, 4
- The likelihood of pregnancy is increased for treatment with IUI compared to timed intercourse (TI) both in stimulated cycles 2