Comparing the effectiveness of IVF/ICSI versus IUI in unexplained infertility

The study compared the pregnancy rates for intrauterine insemination (IUI) and in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) in couples with unexplained infertility. The data concluded that IVF/ICSI is a better treatment option than IUI for unexplained infertility.

Infertility is the inability to conceive after 12 months of unprotected sexual intercourse. Unexplained infertility is when no cause has been found to explain the reason for infertility. Currently, there are various options to treat unexplained infertility such as fertility medications, IUI, and IVF/ICSI.

IUI is the process of placing a man’s sperm directly into the woman’s uterus (womb) using a tube. IVF is the process of stimulating women’s ovaries to produce eggs that are then fertilized with sperm in the lab. The fertilized eggs (embryos) are then transferred into the woman’s uterus. ICSI is the method of injecting sperm directly into the woman’s egg.

The results from past research studies for the management of unexplained infertility are conflicting. Therefore, to know which treatment, IUI or IVF/ICSI is better for women with unexplained infertility need to be investigated.

The study collected data from two assisted reproductive technology (ART) centers. One of the steps in infertility treatments is ovarian stimulation. Ovarian stimulation is the process of injecting hormonal medications to stimulate the ovaries. There were 1659 ovarian stimulations of which 855 were in the IVF/ICSI cycle and 804 in the IUI cycle.

Pregnancy rates were significantly higher in IVF/ICSI (23.0%/cycle) compared to IUI (12.9%/cycle). Live birth rates were also significantly higher in the IVF/ICSI group (17.%/cycles) compared to the IUI group (11%/cycle). There was also a higher rate of miscarriage in the IVF/ICSI group (24.3%) compared to the IUI group (14.4%). These results were true for women under the age of 40. However, there was no difference in pregnancy and live birth rates in women aged 40 and over between IVF/ICSI and IUI.

Women with unexplained infertility had a higher chance of pregnancy during the first two cycles and with a bi-follicular response to stimulation with IUI. Women had better chances of pregnancy in the first two cycles of IVF/ICSI. Also, women who received a transfer of two embryos achieved better results. The rate of twin pregnancy was similar between groups. 

The study concluded that IVF/ICSI is a better option than IUI for managing unexplained infertility. The authors suggested IVF/ICSI should be the first-line treatment for couples with unexplained infertility, regardless of the woman's age. 

The study looked back at medical records. The study only included 2 ART centers based in France. More studies are needed for the general population.

Discuss with your doctor what option is best for you.