The Potential Use of Intrauterine Insemination as a Basic Option for Infertility: A Review for Technology-Limited Medical Settings

Abstract

Objective. There is an asymmetric allocation of technology and other resources for infertility services. Intrauterine insemination (IUI) is a process of placing washed spermatozoa transcervically into the uterine cavity for treatment of infertility. This is a review of literature for the potential use of IUI as a basic infertility treatment in technology-limited settings. Study design. Review of articles on treatment of infertility using IUI. Results. Aspects regarding the use of IUI are reviewed, including ovarian stimulation, semen parameters associated with good outcomes, methods of sperm preparation, timing of IUI, and number of inseminations. Implications of the finding in light of the needs of low-technology medical settings are summarized. Conclusion. The reviewed evidence suggests that IUI is less expensive, less invasive, and comparably effective for selected patients as a first-line treatment for couples with unexplained or male factor infertility. Those couples may be offered three to six IUI cycles in technology-limited settings.

Intrauterine Insemination: Fundamentals Revisited

“…Controlled ovarian hyperstimulation with close monitoring of folliculogenesis and ovulation to avoid adverse complications, such as ovarian hyperstimulation syndrome (OHSS) and multiple pregnancies, may be used to obtain the adequate number of follicles. IUI is the preferred conception-enhancing technique for women \ 35 years, functional tubes, short period of infertility, and moderate male infertility, particularly in technology-limited settings, and four to six IUI cycles may be performed before considering alternate therapy such as IVF [49,50]. It is the method of choice versus timed intercourse or natural cycle IUI [51].…”

The Use of Gonadotropin Releasing Hormone Antagonist in Women Undergoing Intrauterine Insemination

“…Treatment with IUI-H is shorter, less invasive, and less expensive [3], with a lower multiple delivery rate (10.4% vs. 20.2%) and lower morbidity than IVF [2]. The pregnancy rate per cycle (PR) with IUI-H is then comparable to that observed after IVF with mild ovarian stimulation [4].…”

Role of Dominant Follicle Count in Controlled Ovarian Stimulation With Intrauterine Insemination Cycles in Patients With Unexplained Infertility

“…Intrauterine insemination (IUI) is the therapeutic process after semen preparation and concentration of motile spermatozoa in a small volume of culture medium (1). IUI is a preferred method in the treatment of subfertile couples with various causes of subfertility, including cervical factor, male factor and unexplained infertility (2).…”

“…COH-IUI is a simpler, less invasive and cheaper first-line treatment than in-vitro fertilization (IVF) for subfertility, resulting in a acceptable PR 10-20% per cycle (2). Several factors that may influence of COH-IUI outcome, including infertility etiology, woman age, infertility duration, sperm parameters, the use of ovulation induction agents, techniques used for sperm preparation, timing and number of inseminations, thickness of endometrium, total antral follicle count, and number of dominant follicles on the day of human chorionic gonadotropin (hCG) (1,(4)(5)(6). However, the effect of dominant follicles counts on the day of hCG is controversial in current literature (4)(5)(6).…”