ABSTRACT
Recent high-quality studies have shown that intrauterine insemination with homologous semen (i.e., artificial insemination by husband [AIH]) should be the first choice of treatment in cases of unexplained and moderate male factor subfertility. In vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) are clearly overused in this selected group of infertile couples.
Compared to IVF/ICSI, intrauterine insemination (IUI) is easy to learn, requires less equipment, and is less expensive and less invasive with a reasonable success rate within three or four cycles. It is associated with reduced psychological burden and an excellent couple compliance and low drop-out rate. The risk of ovarian hyperstimulation syndrome (OHSS) is reduced, and the rate of multiple pregnancies is also lower when performed in natural cycles or with clomiphene citrate or low-dose human menopausal gonadotropin (hMG) stimulation protocols.
More evidence-based data are becoming available on different variables influencing the success rates after IUI, including the age of both partners, semen-quality parameters, timing and number of cycles to perform, the impact of ovarian stimulation, and the importance of viral infections such as human papilloma virus (HPV). It can be expected that these findings may lead to a better understanding and use of AIH in the near future.
Perinatal outcome results are significantly better after AIH compared to IVF/ICSI, and AIH seems to be the most cost-effective first-line treatment in unexplained and moderate male factor infertility.
