Importance of ultrasound guidance during intrauterine insemination

This study evaluated the effects of ultrasound guidance during intrauterine insemination (IUI) on pregnancy rates. The impact of physician experience on intrauterine insemination success was also assessed.

Intrauterine insemination is often the first treatment attempted by couples experiencing unexplained infertility. During intrauterine insemination, male sperm cells are placed directly inside the female uterus to facilitate fertilization. Several factors, such as manipulation of the cervix and uterine contractions, are known to reduce success rates in intrauterine insemination. Ultrasound imaging during the procedure is thought to reduce the risk of unsuccessful fertilization and implantation. However, the benefits derived from any ultrasound examination are known to be closely associated with the skill level and experience of the examiner.

This trial randomized 387 women to either classic intrauterine insemination or ultrasound-guided intrauterine insemination. Results showed that pregnancy rates were significantly higher in women who underwent ultrasound-guided intrauterine insemination compared to those in the classical intrauterine insemination group. 17.2% of women undergoing ultrasound-guided intrauterine insemination achieved pregnancy compared to 10.1% of women undergoing classical intrauterine insemination.

When analyzing results in respect to medical provider experience, no difference was noted in pregnancy rates among women undergoing classical intrauterine insemination by junior or senior medical providers. However, among women undergoing ultrasound-guided intrauterine insemination, increased pregnancy rates were noted only among women undergoing ultrasound-guided insemination by a senior experienced provider. 

This study concluded that ultrasound-guided intrauterine insemination improves pregnancy rates when provided by an experienced professional, but not when conducted by a junior provider.