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According to a number of high-quality studies, intrauterine insemination (IUI) with homologous semen should be the first choice of treatment in the case of moderate male factor subfertility. IVF and ICSI are clearly over-used in this selected group of infertile couples. The limited value of IUI in infertility treatment, as mentioned in the 2013 NICE guidelines, was surely a premature statement and should be adapted to the actual literature. Oxidative stress and high sperm DNA damage is associated with lower pregnancy rates after IUI. Concerning clinical outcome, there is no clear evidence of any sperm preparation technique to be superior. More evidence-based data are becoming available on different variables influencing the success rates after IUI. It can be expected that these findings may lead to a better understanding and use of IUI in the near future.
Intrauterine insemination (IUI) aims to bypass the cervical-mucus barrier and to increase the number of motile spermatozoa with a high proportion of normal forms at the site of fertilization, as close as possible to the oocytes. In most cases of cervical hostility, unexplained and moderate male infertility, expectant management and timed intercourse (TI) in natural cycles are the first choice option. When unsuccessful, IUI can be promoted as the best first-line treatment in most cases of subfertility provided at least one tube is patent and an inseminating motile count (IMC) of more than 1 million can be obtained after sperm preparation. In a selected group of patients it is unwise to start with assisted reproductive techniques such as in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) since these techniques are more invasive and less cost-effective.