Intrauterine insemination recommended

A randomised trial and cost-effectiveness comparison of intrauterine insemination (IUI) and in vitro-fertilisation (IVF) in couples affected by idiopathic or male subfertility has been undertaken by Dutch scientists. The trial groups were treated with either IUI, IUI with mild ovarian stimulation, or IVF.

The results, published in the Lancet, have shown that with up to six cycles, IUI is almost as effective as IUI with ovarian stimulation or IVF. In addition, the use of IUI is less dangerous in terms of side-effects or multiple pregnancies and is far cheaper than IVF. On average, the cost of a full-term IUI pregnancy is £3,000, compared to £10,000 for IVF.

Some commentators, such as Siladitya Bhattacharya of Aberdeen University, have recommended that IUI alone should be offered as the treatment of first choice for couples with subfertility. IVF was developed initially to circumvent problems of female infertility relating to damaged or non-existent fallopian tubes.

Improvements in the success rate of IVF have encouraged wider use for example in the treatment of unexplained or male subfertility. IVF is an expensive and invasive procedure and the Dutch scientists have shown that it may be largely unnecessary in cases of idiopathic or male subfertility if IUI were employed first. However, the study has failed to take into account certain aspects that affect cost-effectiveness. The freezing of surplus embryos from IVF and subsequent thawing and transfer of such embryos means that subsequent cycles are cheaper. Conversely, the risk of multiple pregnancies resulting from IVF means higher neonatal costs.