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IntraUterine Insemination (IUI) 



IUI + controlled ovarian hyperstimulation (COH) is widely used in cases of unexplained subfertility before resorting to more invasive options like IVF. It involves the placement of washed sperms into the uterine cavity around the time of ovulation. It has been used both with or without ovarian stimulation. A recent Cochrane review has shown that IUI + COH increases live birth rate more than two-fold compared to IUI in a natural cycle (OR 2.07, 95% CI 1.22 - 3.5) [Ref]. COH may correct subtle problems of ovulation, slightly increase the number of oocytes available for fertilisation and thereby increase the chances of pregnancy[Ref]. A major concern however with multiple follicle developments in IUI + COH is multiple pregnancies[Ref]. Using mild ovarian hyperstimulation and strict cancellation policies, the multiple pregnancy rates can be kept to approximately 10% without reducing pregnancy rates [Ref]. Two studies failed to show any benefit of IUI with or without COH over expectant management in terms of live birth rates in these couples57, 66. Based on this evidence NICE recommends not to routinely offer IUI for couples with unexplained subfertility but to proceed directly to IVF after two years infertility. The success of IUI, however, remains a controversial issue as it depends on multiple factors [Ref] and a recent survey of fertility clinicians in the UK with a response rate of 33% found that more than 80% would still consider IUI + COH in these patients [Ref]

Read the latest evidence on IUI in Unexplained infertility


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