Putting sperm directly into a woman’s uterus is no longer popular as a fertility treatment, but new evidence suggests it’s more effective than we thought – as well as being a lot easier and cheaper than IVF.
Infertility is nothing new, and people have been inventing ways to boost their chances of conceiving for centuries. One approach to tackling reduced male fertility, the “turkey baster” method of placing sperm into the vagina, has been around in some form since at least the 1400s.
Improved versions of this procedure, aka intrauterine insemination (IUI), wash the sperm first, to lower the risk of infections, before using a thin tube to deliver the sperm. Sometimes, women are given drugs to increase the number of eggs they release, with the hope of further boosting the chances of success.
But the technique has fallen out of favour in recent years, in part because studies have shown that a single round of IVF is more likely to result in pregnancy than IUI. The UK’s National Institute for Health and Care Excellence recommends couples with unexplained infertility bypass IUI altogether after trying for a year or two, depending on age, the most cost-effective approach is to skip straight to IVF, the guidelines state.
Now Cindy Farquhar of the University of Auckland, New Zealand, and her team have found that IUI is much more likely to lead to pregnancy than we thought. The team compared three rounds of IUI paired with a drug that boosts ovulation against three months of trying to conceive naturally, in 201 couples who were trying to conceive.
The team presented results at the European Society of Human Reproduction and Embryology meeting in Geneva, Switzerland, this month that suggest IUI can increase the live birth rate from 9 per cent to 31 per cent in couples who’ve had unexplained infertility for three to four years.
This could be good news because IUI is much easier than IVF and often around a quarter of the price. The sperm is injected into the uterus through a thin tube, with no need for surgery.
In a study of 602 couples, Ben Cohlen of the Fertility Clinic Isala in Zwolle, the Netherlands, and his team has found that, over six rounds of treatment, IUI has similar success rates to drug-free IVF. “For unexplained or mild male infertility, I would do at least three cycles of IUI before trying IVF,” says Cohlen.
Roy Homburg at Homerton University Hospital in London agrees IUI is worth a try and describes proceeding directly to IVF as being “like using a sledgehammer to crack a nut”.
“We are overusing IVF to treat unexplained infertility,” says Homburg. With carefully chosen couples, and combined with female fertility drugs, IUI is more cost effective and less invasive, he says.