Intrauterine insemination: A critical review

IUI is a treatment that should be reserved for couples with relatively clear indications (e.g., cervical factor infertility) and who are highly motivated to carry out an expensive and stressful program. Although IUI has not been shown to be effective in significantly increasing the overall conception rate for men with oligospermia, there have been some reports of pregnancy with IUI when sperm counts are severely decreased. Further studies are needed for assessment of the use of IUI in immunologic infertility, but preliminary results fail to support this indication and introduce the possibility that IUI may increase the risk of sperm sensitization in women. Sperm preparation should be directed to optimize count and motility and minimize content of seminal plasma, and the timing methods should be assessed carefully for accuracy of predicting ovulation. The treatment period should contain at least three cycles before therapy is abandoned. Patients should be thoroughly counseled about the risks, relative pregnancy rates, and emotional considerations before the initiation of treatment.