Human Reproduction Update, Vol.8, No.4 pp.373-384, 2002
© European Society of Human Reproduction and Embryology 2002; all rights reserved
Intrauterine insemination: a systematic review on determinants of success
1 The Jones Institute for Reproductive Medicine, Department of Obstetrics/Gynecology, Eastern Virginia Medical School, Norfolk, VA, USA 2 Tygerberg Hospital, Department of Obstetrics/Gynecology, University of Stellenbosch, Cape Town, South Africa
To whom correspondence should be addressed at: Sergio Oehninger, The Jones Institute for Reproductive Medicine, Department of Obstetrics/Gynecology, Eastern Virginia Medical School, Norfolk, VA, USA. e-mail: oehninsc{at}evms.edu
Abstract
Intrauterine insemination (IUI) is a frequently indicated therapeutic modality in infertility. Here, a systematic review of the literature was performed to examine the current status of clinical and laboratory methodologies used in IUI and the impact of female and male factors on pregnancy success. Emphasis was centred in questioning the following: (i) the value of IUI against timed intercourse; (ii) IUI application with or without controlled ovarian hyperstimulation; (iii) timing and frequency of IUI; and (iv) impact of various parameters (male/female) on the prediction of pregnancy outcome. The odds of multiple pregnancy occurrence and its risk factors, as well as the cost-effectiveness of IUI treatment compared with more complex assisted reproductive technologies are discussed. A computerized literature search was performed including Medline and the Cochrane library, as well as a crossover search from retrieved papers. It is concluded that although IUI is a successful contemporary treatment for appropriately selected cases of female and/or male infertility, further research is needed through well-designed studies to improve the methodologies currently utilized. Importantly, the clinical management of the infertile couple should be performed in an expedited manner taking into consideration the age of the woman, the presence of multifactorial infertility and cost-effectiveness of the available treatment alternatives.
Key words: cost-effectiveness / double insemination / female or male factors / intrauterine insemination / timed intercourse
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