INTRAUTERINE INSEMINATION - IS IT AN EFFECTIVE TREATMENT FOR MALE FACTOR INFERTILITY

Results were collected from 11 studies comparing intrauterine insemina tion (IUI) with intracervical insemination (ICI) of frozen donor semen , 10 studies comparing IUI with timed natural intercourse (NI) or ICI in couples with semen defects and seven studies comparing ICI with NI or ICI in couples with unexplained infertility. IUI significantly incr eased the pregnancy rate relative to favourably timed ICI in donor ins emination (DI) with frozen semen both with and without gonadotrophin s timulation of the female partner (odds ratios (95% confidence interval ) 1.92 (1.02-3.61) and 2.63 (1.52-4.54) respectively). The benefit of IUI tended to be less when the pregnancy rate for ICI was high and IUI had no benefit with fresh donor semen. Overall IUI was of significant benefit in the male factor couples compared with NI-ICI (odds ratio 2 .20 (1.43-3.39) and the advantage appeared to be maintained when compa rison was confined to properly timed ICI although the odds ratios were not significantly greater than 1. IUI had no benefit relative to favo urably timed NI-ICI for couples with unexplained infertility; an appar ent advantage overall was produced by studies where NI was late. None of the studies on male factor used a sperm function test to define mal e subfertility and three only included couples with good mucus penetra tion by sperm. The range of semen defects defined was such that many c ouples would have had a good chance of conceiving naturally given a no rmal female partner but nevertheless the overall pregnancy rate (4.8%) was considerably less than in the unexplained group (11.6%), suggesti ng that some sperm dysfunction was present. We conclude that the avail able evidence suggests that IUI is valuable for DI with cryopreserved semen and for couples with mild to moderately impaired semen quality a nd postulate that it overcomes failure to fertilize due to impaired mu cus penetration and poor survival in the female reproductive tract.