Intrauterine Technique Makes Pregnancy More Likely
Dec. 6, 1999 (Los Angeles) -- Intrauterine insemination (IUI) with frozen donor sperm more than doubles a woman's chances of conceiving over intracervical insemination (ICI), according to a paper in the November issue of the journal Fertility and Sterility. "The point of our study is to make people aware that there is a difference. There's really no reason not to do IUI," lead author Jeffrey Goldberg, MD, tells WebMD.
With ICI, semen is simply injected into the cervical canal, while for IUI, the sperm must be separated from the semen before it is deposited directly into the uterus.
Goldberg, who is director of the In Vitro Fertilization Program at the Cleveland Clinic, and his colleagues conducted an analysis of studies that provided monthly success rates for IUI and ICI and that used only frozen donor sperm. They searched a database dating back to 1966 and reviewed books from various medical meetings dating from 1990 for unpublished studies. In all, seven studies met their criteria. The authors then contacted the investigators of those studies in the hopes of obtaining the original raw data, and were successful in three cases.
For the combined raw data and reported results, a woman's odds of becoming pregnant on a given insemination attempt were estimated to be 2.4 times higher for those using IUI, the authors report, possibly because IUI may deliver more mobile sperm to the site of fertilization.
"I absolutely agree with the findings of this study -- that's been our experience," says Daniel B. Williams, MD, associate professor, division of reproductive endocrinology and infertility at Washington University School of Medicine in St. Louis. Williams, who was one of the investigators to share their raw data for this analysis, tells WebMD that "at this point I would be surprised if any clinician were still doing intracervical insemination."
One drawback is that IUI is more expensive. However, says Williams, "the extra cost can be justified in terms of the increased pregnancy rates." Says Goldberg, "since you're more than doubling your chances of pregnancy, IUI is very cost-effective." He estimates that one attempt of IUI costs $100-$200 more than a comparable cycle of ICI. There are no adverse effects and no contraindications to IUI if frozen sperm is used, and it is comparable to getting a Pap smear in terms of patient discomfort and time. He and his co-authors conclude that "Intrauterine insemination should be the preferred technique for artificial insemination with frozen donor sperm."