Clinical utility of ovarian-stimulation intrauterine insemination


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Volume 109, Issue 5, Pages 795–796


Robert A. Wild, M.D., Ph.D., M.P.H.


Reflections on "Ovarian stimulation in infertile women treated with intrauterine insemination: a cohort study from China" by Huang et al.

Read the full text here.

Fertility and Sterility

Editorial Office, American Society for Reproductive Medicine

Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders. 


Go to the profile of Alexander Quaas
over 3 years ago


I read your Reflections piece and the associated study by Huang et al. with great interest, as there is a big debate here in Europe regarding the utility of IUI in unexplained infertility. In lectures and symposia, I heard repeatedly that based on Cochrane reviews there is insufficient evidence that IUI is superior compared to sexual intercourse in couples with unexplained subfertility. One professor compared the issue with the principle presented in a novel by  Céline: “Since most diseases resolve spontaneously after 5 days, the smart doctor starts to prescribe medication on day 3.” 

In the UK, the National Institute for Health Care Excellence (NICE) advised in its most recent fertility guideline that IUI should no longer be offered in unexplained infertility, and recommends 2 years of sexual intercourse followed by IVF.  A 2015 survey study showed that 96% of fertility clinics in the UK continued to offer IUI despite these recommendation (Kim, D., T. Child, and C. Farquhar, Intrauterine insemination: a UK survey on the adherence to NICE clinical guidelines by fertility clinics. BMJ Open, 2015. 5(5))

The study by Huang et al. is retrospectice and does not have an expectant management group, as far as I can tell. So it will not count as "sufficient evidence" to overturn opinions and NICE guidelines. The 2018 Farquhar study from New Zealand was a "pragmatic, open-label, randomised, controlled, two-centre study" on 201 patients, clearly demonstrating superiority of IUI with ovarian stimulation over expectant management.

Is this evidence sufficient or is another RCT of IUI compared to expectant management with sexual intercourse needed? Will it happen?

Thank you!