Male infertility is a common condition and intrauterine insemination (IUI) is used to treat the mild to moderate forms. Male subfertility determination is usually based on routine semen analysis but recent publications have questioned its diagnostic and prognostic accuracy as well as the effectiveness of IUI itself, as a treatment modality. The presence of seminal defects compromises the outcome of IUI in comparison with unexplained infertility. The total motile sperm count appears to have a consistent, direct relationship with treatment outcome, but there is no definite predictive threshold for success. However, it is reasonable to offer IUI as first-line treatment if total motile sperm count is greater than 10 million when balancing the risk and cost of alternate treatments, such as in vitro fertilization (IVF).
According to NICE guidelines, IUI is used to manage male factor infertility where semen is of sufficient quality for there to be 2-5 million motile sperm. Approximately 15% of couples are unable to conceive after one year of unprotected intercourse. A male factor is solely responsible in about 20% of infertile couples and informative in another 30-40%. Despite these estimates, the true prevalence of male infertility is not clearly defined due to multiple factors including variations in definitions of infertility, differences in sources of data, and the populations studied.
Identification and treatment of reversible conditions may improve the male’s fertility and allow for conception through intercourse or through techniques, such as IUI or IVF, when those approaches would otherwise not be possible. Even azoospermic patients may have some degree of active sperm production within the testes or could have sperm production induced with treatment. Identification of conditions for which there is no treatment will spare couples the distress of attempting ineffective therapies and allow them to consider options, such as donor sperm or adoption, if appropriate.
Most couples achieve a pregnancy in the first 3 to 6 months of attempted conception, with 75% of couples achieving a pregnancy after 6 months of trying. In general, after one year of attempting to conceive, approximately 85% of couples will have achieved a pregnancy. After two full years of attempting to conceive, this statistic has increased to over 90% of couples.
The success rates of IUI for male infertility vary depending on the treatment protocol. Typically, medicated IUI cycles produce higher success rates than unmedicated ones.
- Unmedicated IUI cycles produce pregnancy rates of 6-10% per cycle.
- IUI cycles with Clomid have pregnancy rates of 8-12% per cycle.
- IUI cycles with letrozole (Femara) have pregnancy rates of 10-15% per cycle.
- IUI cycles with gonadotropins have pregnancy rates of 20-25% per cycle.
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