IUI: why you shouldn’t have artificial insemination

IUI, an artificial insemination technique, is fighting for its survival. Well, in the UK at least. If you thought you’d get IUI on the NHS, prepare to be disappointed. In early 2013, NICE guidelines recommended, in effect, a phasing out of IUI on the NHS. Will GP commissioning groups take any notice? Yes, probably. Unlike other NICE initiatives on state-funded fertility treatment, stopping IUI is a cut, not an offer. The recessionary UK likes cuts – a lot.

IUI (intrauterine insemination) had previously been a quick, simple fertility treatment for, predominantly, couples with unexplained infertility or related issues. NICE had advised up to six goes for that group in 2004. The new guidance says forget about IUI on the NHS, period. Have regular unprotected sex for two years; and after that, they say, you may get IVF. ‘May’ being the operative word: read more about the IVF postcode lottery here.

Poor IUI. Most people talked about how the new guidelines advised access to state IVF for women over 40, and to gay people. Then they talked about why few funders will implement them. But the IUI news was unceremoniously overlooked. Given that success rates for IUI are low (15% if you’re lucky) and that IUI had often been used as a ‘keep IVF at bay’ strategy, perhaps its sidelining was a good move. Improving success rates for standard IVF, donor egg-IVF and frozen embryo transfers are perhaps beginning to show IUI for what it is: cheap and unimpressive. Move on to IVF quicker, was the message. Just don’t expect the NHS to pay for it.

On the face of it, IUI seems credible. Stimulate follicle growth in the female partner. Get a medical practitioner to inject washed sperm into the womb via a catheter. Rest  for 15 minutes. Job done. It’s more successful than intracervical insemination (the DIY method that Hollywood films embrace via the proverbial turkey baster), cheaper than IVF and worth a punt.

Or is it? If an IUI cycle costs £1,000 and an IVF cycle costs £1,600 (okay, you have to have the IVF abroad), would you choose IUI? Not only is IVF at least twice as likely to succeed for some women, it also produces eggs that can be harvested, developed and analysed outside the body. The resulting embryos can also be vitrified for a follow-up FET cycle. If it’s all in the figures, NICE has got IUI’s number.

For some, IUI always seemed a little un-medical. Perhaps IUI’s roots, in primitive artificial insemination practices in livestock, contribute to its image problem. Other negatives are the scandalous use of artificial insemination during the Nazi era, the opposition to it by the Catholic Church and the legal complexities surrounding sperm donation and parental and offspring rights.

But IUI is here to stay: the rise of sperm banks in the 1970s gave it commercial momentum. As fertility issues in male and female partners continue to rise, IUI may continue to be seen as a sensible option for male-related fertility issues. Problem is, IUI is just not that great at getting women pregnant.