IUI Is a Valuable and Cost-Effective Therapy for Most Couples

  • Lobke M. Moolenaar
  • Bradley J. Van Voorhis
  • Fulco van der Veen


Cost-effectiveness of IUI has been addressed in only few randomized controlled trials. These trials are difficult to compare because they differ in patient characteristics, included costs, and treatment strategies. Despite these differences, current evidence shows that expectant management is the first-line treatment option in couples with a favorable prognosis for natural conception. Follow-up treatment with IUI is more cost-effective than immediate IVF. The duration of treatment with IUI before proceeding to IVF and the additional value of ovarian stimulation are unclear. An important omission in the present studies is the lack of including the costs caused by multiple gestations and the prognostic profile of the included couples. A study is currently being performed in couples with a poor prognosis for natural conception with mild male or unexplained infertility. This study compares six cycles of IUI, three cycles of IVF eSET, or six cycles of modified natural cycle IVF. This study may give the final answer about which strategy is the most cost-effective strategy for couples after expectant management failed.


Pregnancy Rate Ovarian Stimulation Multiple Pregnancy Expectant Management Natural Conception 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Van Voorhis BJ, Sparks AE, Allen BD, et al. Cost-effectiveness of infertility treatments: a cohort study. Fertil Steril. 1997;67(5):830–6.PubMedCrossRefGoogle Scholar
  2. 2.
    NCCWCH. Clinical Guideline 11. Fertility: assessment and treatment for peole with fertility problems. 2004.
  3. 3.
    RCOG. The management of infertility in secondary care. 1998.
  4. 4.
    Quaas A, Dokras A. Diagnosis and treatment of unexplained infertility. Rev Obstet Gynecol. 2008 Spring;1(2):69–76.Google Scholar
  5. 5.
    Hunault CC, Habbema JD, Eijkemans MJ, et al. Two new prediction rules for spontaneous pregnancy leading to live birth among subfertile couples, based on the synthesis of three previous models. Hum Reprod. 2004;19(9):2019–26.PubMedCrossRefGoogle Scholar
  6. 6.
    Steures P, van der Steeg JW, Hompes PG, et al. Intrauterine insemination with controlled ovarian hyperstimulation versus expectant management for couples with unexplained subfertility and an intermediate prognosis: a randomised clinical trial. Lancet. 2006;368(9531):216–21.PubMedCrossRefGoogle Scholar
  7. 7.
    Custers IM, van Rumste MM, van der Steeg JW, et al. Long-term outcome in couples with unexplained ­subfertility and an intermediate prognosis initially randomized between expectant management and immediate treatment. Hum Reprod. 2012;27(2): 444–50.PubMedCrossRefGoogle Scholar
  8. 8.
    Reindollar RH, Regan MM, Neumann PJ, et al. A randomized clinical trial to evaluate optimal treatment for unexplained infertility: the fast track and standard treatment (FASTT) trial. Fertil Steril. 2010;94(3): 888–99.PubMedCrossRefGoogle Scholar
  9. 9.
    Karande VC, Korn A, Morris R, et al. Prospective ­randomized trial comparing the outcome and cost of in vitro fertilization with that of a traditional ­treatment algorithm as first-line therapy for couples with infertility. Fertil Steril. 1999;71(3):468–75.PubMedCrossRefGoogle Scholar
  10. 10.
    Goverde AJ, McDonnell J, Vermeiden JP, et al. Intrauterine insemination or in-vitro fertilisation in idiopathic subfertility and male subfertility: a randomised trial and cost-effectiveness analysis. Lancet. 2000;355(9197):13–8.PubMedCrossRefGoogle Scholar
  11. 11.
    Custers IM, Konig TE, Broekmans FJ, et al. Couples with unexplained subfertility and unfavorable prognosis: a randomized pilot trial comparing the effectiveness of in vitro fertilization with elective single embryo transfer versus intrauterine insemination with controlled ovarian stimulation. Fertil Steril. 2011;96(5):1107–11.e1.PubMedCrossRefGoogle Scholar
  12. 12.
    Bensdorp AJ, Slappendel E, Koks C, et al. The INeS study: prevention of multiple pregnancies: a randomised controlled trial comparing IUI COH versus IVF e SET versus MNC IVF in couples with unexplained or mild male subfertility. BMC Womens Health. 2009;9:35.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Lobke M. Moolenaar
    • 1
  • Bradley J. Van Voorhis
    • 2
  • Fulco van der Veen
    • 3
  1. 1.Center for Reproductive Medicine, Academic Medical CenterUniversity of AmsterdamAmsterdamThe Netherlands
  2. 2.Center for Advanced Reproductive CareUniversity of IowaIowa CityUSA
  3. 3.Amsterdam Academic Medical CentreUniversity of AmsterdamAmsterdamThe Netherlands

Personalised recommendations