IUI: why you shouldn’t have artificial insemination

IUI, or artificial insemination, is fighting for its survival. Well, in the UK at least. If you thought you’d get IUI on the NHS,  you could be disappointed. Guidelines have recommended a reduction in state-funded IUI. Why?

IUI (intrauterine insemination) is a quick, simple fertility treatment. It was once popular. But the revised NICE guidelines discourage IUI in most cases. For unexplained infertility, low-quality sperm or mild endometriosis, the advice is to have regular unprotected sex for two years. After that, proceed direct to IVF.

The only other way to have IUI treatment on the NHS is if you’re unable to have sexual intercourse, are in a same-sex relationship or have a viral infection transmittable via sex. That’s still the minority of patients.

Success rates for IUI are low (10% per cycle). Stimulated IUI, in particular, isn’t great at lowering the multiple-pregnancy risk. So perhaps downgrading the treatment was a good move. Improved success rates for other fertility treatments, and the safety of single embryo transfers, seems to show IUI for what it is: cheap, but clunky.

On the face of it, IUI appears credible as a first-step approach. Stimulate/monitor follicle growth. Inject washed sperm into the womb. Nice and simple. And more successful than intra-cervical insemination (the DIY method).

It’s all in the numbers. If an IUI cycle costs £1,000 and an IVF cycle costs £5,000 (or much less at our clinic), would you choose IUI? Not only is IVF at least twice as likely to succeed, it also produces eggs that can be harvested and screened. Sperm can be checked and optimised. Embryos can be transferred (one at a time), graded, tested and frozen. It’s a better service. And worth, many think, the extra cash.

Yet, despite all this, IUI has had a resurgence in the last two years. An impressive IUI study in 2018 looked more closely at the pros and cons of IUI. It questioned past research that dismissed IUI out of hand. And it proposed clearer recommendations on when IUI could help. More natural approaches to fertility treatments are being encouraged. The simplicity of IUI may be its trump card.

IUI may be here to stay. As fertility treatments open out to a wider group of would-be parents, IUI is, once again, emerging as a sensible first option. It may not be great at getting women pregnant. But its benefits are being reassessed, right now.