Intrauterine Insemination Efficacy in Infertility Treatment

Intrauterine insemination (IUI) represents a first‐line assisted reproduction technique, involving the direct placement of washed sperm into the uterine cavity around the time of ovulation. Its relative simplicity, lower cost and less invasive nature compared with in vitro fertilisation (IVF) has ensured its widespread global adoption. Over recent years, research has focused on refining stimulation protocols, identifying predictive factors of success and establishing optimal patient selection criteria. Key determinants of efficacy include female age, duration and aetiology of infertility, sperm parameters, endometrial receptivity and stimulation regimen. Strategies such as tailoring ovarian stimulation to ovulatory disorders, monitoring dominant follicle size and applying cycle limits have been shown to influence clinical pregnancy and live birth rates. While IUI yields modest per‐cycle success rates, typically 10–20%, cumulative outcomes over multiple cycles can approach those of more complex treatments in selected cohorts. Its role as a bridge between expectant management and advanced ART remains pivotal, particularly in resource‐limited settings and for couples with mild male factor or unexplained infertility.

Research from Nature Portfolio

Recent studies have examined the relationship between semen quality and IUI outcomes. One foundational investigation assessed total sperm count, concentration and motility across multiple inseminations and found no significant correlation with clinical pregnancy probability. Notably, this analysis suggested that conception rates plateau after five cycles, supporting a five‐cycle limit to optimise resource utilisation without compromising cumulative success.

Intrauterine Insemination Efficacy in Infertility Treatment publication trend

The graph below shows the total number of articles in intrauterine insemination efficacy in infertility treatment across all publications each year (not limited to Nature Index journals).

Technical terms

Intrauterine insemination (IUI): Assisted reproduction procedure in which processed sperm are deposited directly into the uterus to facilitate fertilisation.

Ovarian stimulation: Use of pharmacological agents (e.g., letrozole, clomifene citrate, gonadotrophins) to induce the development of one or more ovarian follicles.

Clinical pregnancy rate (CPR): Proportion of treatment cycles resulting in ultrasound‐confirmed intrauterine gestation.

Live birth rate (LBR): Proportion of treatment cycles culminating in the birth of at least one live infant.

Dominant follicle: The largest ovarian follicle selected for ovulation during a stimulated or natural cycle, typically measured by diameter on the day of trigger.

Normogonadotropic oligomenorrhoea: A menstrual disorder characterised by infrequent ovulation despite normal gonadotrophin levels.

References

1. Improved reproductive outcomes in normogonadotropic oligomenorrheic women undergoing ovarian stimulation with intrauterine insemination: a retrospective cohort analysis of real-world data. Frontiers in Endocrinology (2024).
2. Effect of follicle size on pregnancy outcomes in patients undergoing first letrozole-intrauterine insemination. European Journal of Medical Research (2024).
3. CNFE-SE: a novel approach combining complex network-based feature engineering and stacked ensemble to predict the success of intrauterine insemination and ranking the features. BMC Medical Informatics and Decision Making (2021).
4. Predictive factors for pregnancy after intrauterine insemination: A prospective study of factors affecting outcome. Journal of Human Reproductive Sciences (2010).
5. First line fertility treatment strategies regarding IUI and IVF require clinical evidence. Human Reproduction (2016).
6. Correlation between total sperm count and sperm motility and pregnancy rate in couples undergoing intrauterine insemination. Scientific Reports (2020).