Intrauterine insemination in unexplained female infertility

Abstract

Unexplained infertility (UI) is diagnosed when the standard work-up reveals normal semen analysis, normal uterus with bilateral tubal patency, and regular ovulatory cycles. The true prevalence is still debatable but it is generally accepted to affect about 20 % of infertile couples. The treatment of UI is empirical since the true reasons of the reproductive dysfunction(s) are unknown. Expectant management (EM) with proper instructions to time intercourse could be suggested as first step in the treatment algorithm, followed by intrauterine inseminations (IUIs), with or without controlled ovarian stimulation (COS). After failed cycles of IUI, assisted reproductive technologies as conventional in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) are the proposed subsequent steps. The gonadotrophin-stimulated IUI cycles are considered a better option than natural cycles IUI. A recent Cochrane review showed that the addition of COS to IUI treatment improves live-birth rates (LBRs) in couples with UI. Likewise, a small but still statistically significant increase in pregnancy rate was found with IUI when compared with timed intercourse (TI) in stimulated cycles. The overall success rate in couples with UI is high. However, the criteria for deciding when to suggest IUI or IVF need to be investigated in randomized controlled trials.