This study evaluated the effectiveness and cost of intrauterine insemination (IUI) as a first-line fertility treatment compared to in vitro fertilization (IVF) using data from 859 couples who received 1875 IUI cycles. A live birth rate of 11.5% was achieved after 3 IUI cycles at a cost of €7800 per birth, lower than the estimated €15400 for IVF. A survey found that while IUI success rates were lower than IVF, 93.8% of couples preferred attempting IUI first due to its lower discomfort, risk and cost compared to IVF. The study concludes that IUI is a cost-effective first-line treatment option for couples based on clinical

1. Introduction
• IUI is a low complexity therapy recommended by many as a first-line
treatment for mild or unexplained fertility.
• IUI pregnancy rates are higher than for natural conception but lower than
more high-technology invasive treatments such as IVF.
• Advantages of IUI include: outpatient treatment with no surgery, low cost,
less use of gonadotrophin stimulation and less complications.
• In the UK, NICE now recommends that IUI should no longer be used as a
first-line treatment for unexplained infertility (NICE GC156, 2013).
Who are NICE?
• In the UK, NICE is a well-respected public body providing national guidance
and advice to improve health and social care, and the outcomes for people
using the National Health Service (NHS).
• NICE reviews available evidence & gives advice accordingly, including
consideration of health economics. In the absence of robust evidence that a
specific treatment is effective, NICE has historically concluded that there is
no evidence to support implementation of that treatment.
• NICE guidance is adopted by the NHS, local authorities & commissioners.
• This study aimed to look at whether IUI was an effective first-line treatment
for our patients and to seek their views on the IUI service they received.
Materials and Methods
• Success rates (clinical pregnancy rates and live birth rates) were calculated
from 859 couples having 1875 cycles of IUI treatment combined with mild
gonadotrophin stimulation. A questionnaire was then sent to a random
sample of treated couples, whether successful or not, to seek their views on
the IUI service they had received.
Results
• From 2009-2014, heterosexual couples (median ♀ age 34 years, range 21-
44 years) with unexplained infertility, anovulation problems and/or
borderline male factor received IUI treatment at our fertility clinic.
• A live birth rate of 11.5% was achieved for all IUI couples. 31.2% of couples
achieved a pregnancy within three IUI attempts.
• The estimated cost per live birth was €7800. Costs were calculated to
include equipment, consumables and manpower (also accounting for
annual leave and overheads).
• Costs were then compared with NHS-funded institutions (IUI / IVF) in our
local region of the UK (East Midlands) and a mean average was calculated.
TABLE I – IUI Success Rates And Costs
.
Results
TABLE II – Patient Success Rates & Perceptions Of Success (n=29)
• From the survey, 78.1% couples attended for unexplained infertility, whilst
18.8% had anovulation problems.
• 44.8% couples were offered IVF as an alternative to IUI at the initial
consultation, whilst 51.7% were offered IVF after three IUI attempts.
• Expectations of success were low for 27.6% couples and moderate to
high for 34.5% couples. 90.6% couples considered IUI to have a low level
of discomfort and risk and were therefore satisfied with the decision to
choose IUI over IVF treatment.
• 93.8% stated that they would prefer the offer of less invasive treatment
via IUI rather than going straight to IVF.
TABLE III –Patient Perceptions Of IUI Versus IVF (n=32)
• 90.6% stated they were satisfied to attempt conception via IUI rather than
go straight to IVF treatment.
Conclusions
• Despite the relatively low success rate of IUI compared to IVF, the survey
showed that couples preferred to be given the chance to conceive without
invasive therapy. Moreover, with a 11.5% live birth rate per IUI, the cost
per take home baby after IUI was significantly less than for IVF.
• A wider survey might reveal different responses, although from the data
provided, there was an overwhelming trend for patients supporting
access to IUI as a first-line treatment for unexplained infertility.
Reference: National Institute for Health and Care Excellence guidelines [CG156] Fertility:
Assessment and treatment for people with fertility problems. Published date: February 2013.
Is intra-uterine insemination (IUI) a cost-effective service?
Evidence of success & patient satisfaction from a UK clinic
specialising in IUI
BJ Woodward, D Littlehales, N Cotgreave-Keates, K Pooley, T Kohut, S Deb & MJ Tomlinson
Fertility Unit,
Nottingham University Hospital,
Nottingham, NG7 2UH, UK
How did you view IUI in terms of discomfort and risk?
Low discomfort and risk 29
Moderate discomfort and risk 3
Were you satisfied in being given the chance to conceive using IUI or would
you have preferred to go straight to IVF treatment?
Satisfied 29
Would have preferred IVF 3
Knowing that only 1 attempt at IVF treatment can be made on the NHS, would
you prefer the chance to conceive using IUI first or prefer to go straight to IVF?
Chance of conceiving with IUI 30
Would prefer to move straight to IVF 2
Have you been successful?
Not yet 14
After 1 attempt 4
After 2 attempts 4
After 3 attempts 2
Were you offered IVF instead of IUI treatment?
Yes at the same time as IUI 13 (44.8%)
Yes after 3 attempts 15 (51.7%)
How did you view IUI in terms of chance of success?
Low expectation 8 (27.6%)
Low to moderate 13 (44.8%)
Moderate to high 10 (34.5%)
IUI Success Rates
Clinical pregnancy rate / 3 cycles IUI 31.2%
Clinical pregnancy rate / IUI 14.9%
Live birth rate / IUI 11.5%
Estimated cost per live birth / IUI €7800
Estimated cost per live birth / IVF €15400