IUI versus IVF: Why the debate over first-line infertility treatment is heating up

Unexplained infertility accounts for approximately 25% of infertility cases, leaving couples and clinicians with challenging decisions regarding the best course of treatment. Traditionally, in vitro fertilization (IVF) has been favored as the first-line treatment, particularly following guidelines from the National Institute for Health and Care Excellence (NICE). However, recent guidelines from the European Society for Human Reproduction and Embryology (ESHRE) have reignited the debate by supporting intrauterine insemination (IUI) with ovarian stimulation (OS) as a viable first-line option for couples with unexplained infertility.

This literature review critically examines the outcomes associated with IUI-OS and IVF, focusing on live birth (LB) rates, clinical pregnancy (CP) rates, and ongoing pregnancy (OP) rates. The evidence reveals a complex picture, with some studies showing comparable LB rates between IUI-OS and IVF, particularly in younger women with good prognoses. The cost-effectiveness and less invasive nature of IUI-OS are key advantages that make it an appealing option for initial treatment. However, IVF remains superior in certain scenarios, particularly for women over the age of 38, where LB rates are significantly higher compared to IUI-OS.

While IUI-OS may offer a promising alternative, especially for those seeking a less invasive and more affordable treatment, the decision between IUI-OS and IVF should be individualized based on patient-specific factors such as age, ovarian reserve, and previous treatment history. Further high-quality randomized controlled trials are needed to provide more definitive guidance on the optimal use of IUI-OS versus IVF in managing unexplained infertility.