Clinical utility of ovarian-stimulation intrauterine insemination

Reflections

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Volume 109, Issue 5, Pages 795–796

Authors:

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

Abstract:

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


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1 Comments

Go to the profile of Alexander Quaas
Alexander Quaas 6 days ago

Bob,

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!