Double intrauterine insemination (IUI) of no benefit over single IUI among lesbian and single women seeking to conceive

  • Brent C. MonseurEmail author
  • Jason M. Franasiak
  • Li Sun
  • Richard T. ScottJr
  • Daniel J. Kaser
Assisted Reproduction Technologies



To explore clinical benefit of performing two intrauterine inseminations (IUI) 24 h apart—a double IUI vs. a single IUI among lesbian and single women.


Retrospective cohort study using electronic medical record review during a 17-year period (11/1999–3/2017). A total of 11,396 patients at a single academic-affiliated private practice were included in this study. All cycles with a single or double IUI were included. A sub-analysis of first cycles only (n = 10,413) was also performed. Canceled IVF cycles converted to IUI were excluded. T tests and Wilcoxon rank-sum tests were used for continuous data, and chi-square for categorical data. Multivariable logistic regression controlled for patient age, day 3 follicle-stimulating hormone (D3 FSH), body mass index (BMI), peak estradiol (E2), and post-wash total motile sperm counts to model the association between IUI number and ongoing pregnancy rate (OPR) according to sperm source (autologous vs. donor). Generalized estimating equations and mixed effect models accounted for multiple cycles from the same woman. Adjusted odds ratio (AOR) with 95% CI was determined. Sub-analyses of sexual orientation and partner status were performed to compare heterosexual couples with proven infertility to women with lesbian and single women.


During the study period, 22,452 cycles met inclusion criteria (single IUI 1283 vs. double IUI 21,169). Mean patient age and BMI were similar between groups. For couples using autologous sperm, OPR was significantly higher with double IUI (12.0% vs. 14.1%; p = 0.0380). A similar increase was observed for donor sperm OPR among heterosexual couples (14.4% vs. 16.2%), though this did not reach statistical significance (p = 0.395). A sub-analysis restricted to donor sperm demonstrates a clinical benefit of second IUI in heterosexual couples, 8.5% vs. 17.6% OPR (AOR 2.94; CI 1.00–10.99; p = 0.0496). When lesbian and single patients were evaluated, there was no difference (17.2% vs. 15.2%; AOR 0.99; CI 0.59–1.70; p = 0.0958).


Double IUI is associated with a significantly higher OPR for heterosexual couples using an autologous or donor sperm source. The benefit of a second IUI is less clear in patients with undocumented fertility status using donor sperm, such as single and lesbian women.


Pregnancy rate; insemination Autologous Donor Fertility Lesbian LGBTQ Intrauterine insemination 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Access to fertility services by transgender persons: an Ethics Committee opinion. Fertil Steril. 2015;104:1111–5.Google Scholar
  2. 2.
    Access to fertility treatment by gays, lesbians, and unmarried persons: A committee opinion. Fertil Steril. 2013;100:1524–7.Google Scholar
  3. 3.
    Temple-O’Connor MD, Wehr E, NIH LGBT. Research coordinating committee. In: Wk. 6 consideration of the Institute of Medicine Report on the “health of lesbian, gay, biesexual, and transgender individuals”; 2011.Google Scholar
  4. 4.
    Carpinello OJ, Jacob MC, Nulsen J, Benadiva C. Utilization of fertility treatment and reproductive choices by lesbian couples. Fertil Steril. 2016;106:1709–1713.e4.CrossRefGoogle Scholar
  5. 5.
    Tarín JJ, García-Pérez MA, Cano A. Deficiencies in reporting results of lesbians and gays after donor intrauterine insemination and assisted reproductive technology treatments: a review of the first emerging studies. Reprod Biol Endocrinol. 2015;13:52.CrossRefGoogle Scholar
  6. 6.
    Ferrara I, Balet R, Grudzinskas JG. Intrauterine donor insemination in single women and lesbian couples: a comparative study of pregnacny. Hum Reprod Englert. 2000;15:621–5.CrossRefGoogle Scholar
  7. 7.
    Ombelet W. The revival of intrauterine insemination: evidence-based data have changed the picture. Facts, views Vis ObGyn. 2017;9:131–2.Google Scholar
  8. 8.
    Bahadur G, Homburg R. Reappraisal of clinical data supports double IUI for improved pregnancy outcomes. Facts, views Vis ObGyn Vlaamse Vereniging voor Obstetrie en Gynaecologie. 2018;10:45–6.Google Scholar
  9. 9.
    Bahadur G, Homburg R, Al-Habib A. A new dawn for intrauterine insemination: efficient and prudent practice will benefit patients, the fertility industry and the healthcare bodies. J Obstet Gynecol India. 2017;67:79–85.CrossRefGoogle Scholar
  10. 10.
    Cantineau AE, Heineman MJ, Cohlen BJ. Single versus double intrauterine insemination (IUI) in stimulated cycles for subfertile couples. Cochrane Database Syst Rev. 2003.Google Scholar
  11. 11.
    Cantineau AEP, Heineman MJ, Cohlen BJ. Single versus double intrauterine insemination in stimulated cycles for subfertile couples: a systematic review based on a Cochrane review. Hum Reprod. Oxford University Press. 2003:941–6.Google Scholar
  12. 12.
    Liu W, Gong F, Luo K, Lu G. Comparing the pregnancy rates of one versus two intrauterine inseminations (IUIs) in male factor and idiopathic infertility. J Assist Reprod Genet. 2006;23:75–9.CrossRefGoogle Scholar
  13. 13.
    Garas A, Polyzos NP, Papanikolaou E, Anifandis G, Daponte A, Verykouki C, et al. Double versus single homologous intrauterine insemination for male factor infertility: a systematic review and meta-analysis. Asian J Androl. 2013;15:533–8.CrossRefGoogle Scholar
  14. 14.
    Bagis T, Haydardedeoglu B, Kilicdag EB, Cok T, Simsek E, Parlakgumus AH. Single versus double intrauterine insemination in multi-follicular ovarian hyperstimulation cycles: a randomized trial. Hum Reprod. Oxford University Press. 2010;25:1684–90.CrossRefGoogle Scholar
  15. 15.
    Ghanem ME, Bakre NI, Emam MA, Al Boghdady LA, Helal AS, Elmetwally AG, et al. The effects of timing of intrauterine insemination in relation to ovulation and the number of inseminations on cycle pregnancy rate in common infertility etiologies. Hum Reprod. 2011;26:576–83.CrossRefGoogle Scholar
  16. 16.
    Randall GW, Gantt PA. Double vs. single intrauterine insemination per cycle: use in gonadotropin cycles and in diagnostic categories of ovulatory dysfunction and male factor infertility. J Reprod Med. 2008;53:196–202.Google Scholar
  17. 17.
    Zarek SM, Hill MJ, Richter KS, Wu M, Decherney AH, Osheroff JE, et al. Single-donor and double-donor sperm intrauterine insemination cycles: does double intrauterine insemination increase clinical pregnancy rates? Fertil Steril. 2014;102:739–43.CrossRefGoogle Scholar
  18. 18.
    Khalifa Y, Redgment CJ, Tsirigotis M, Grudzinskas JG, Craft IL. The value of single versus repeated insemination in intra-uterine donor insemination cycles. Hum Reprod Oxford University Press. 1995;10:153–4.CrossRefGoogle Scholar
  19. 19.
    Matilsky M, Geslevich Y, Ben-Ami M, Ben-Shlomo I, Weiner-Megnagi T, Shalev E. Two-day IUI treatment cycles are more successful than one-day IUI cycles when using frozen-thawed donor sperm. J Androl. 19:603–7.Google Scholar
  20. 20.
    Chavkin DE, Molinaro TA, Roe AH, Sammel MD, Dokras A. Donor sperm insemination cycles: are two inseminations better than one? J Androl. 2012;33:375–80.CrossRefGoogle Scholar
  21. 21.
    Duran HE, Morshedi M, Kruger T, Oehninger S. Intrauterine insemination: a systematic review on determinants of success intrauterine insemination versus timed intercourse/intracervical insemination natural cycle versus ovarian stimulation in conjunction with intrauterine insemination timing/induction. Hum Reprod Update. 2002;8:373–84.CrossRefGoogle Scholar
  22. 22.
    Osuna C, Matorras R, Pijoan JI, Rodríguez-Escudero FJ. One versus two inseminations per cycle in intrauterine insemination with sperm from patients’ husbands: a systematic review of the literature. Fertil Steril. 2004;82:17–24.CrossRefGoogle Scholar
  23. 23.
    Nordqvist S, Sydsjö G, Lampic C, Åkerud H, Elenis E, Skoog Svanberg A. Sexual orientation of women does not affect outcome of fertility treatment with donated sperm. Hum Reprod. 2014;29:704–11.CrossRefGoogle Scholar
  24. 24.
    Farr SL, Schieve LA, Jamieson DJ. Pregnancy loss among pregnancies conceived through assisted reproductive technology, United States, 1999-2002. Am J Epidemiol Narnia. 2007;165:1380–8.CrossRefGoogle Scholar
  25. 25.
    Ripley M, Lanes A, Léveillé M-C, Shmorgun D. Does ovarian reserve predict egg quality in unstimulated therapeutic donor insemination cycles? Fertil Steril. 2015;103:1170–5 e2.CrossRefGoogle Scholar
  26. 26.
    Kaser DJ, Goldman MB, Fung JL, Alper MM, Reindollar RH. When is clomiphene or gonadotropin intrauterine insemination futile? Results of the fast track and standard treatment trial and the forty and over treatment trial, two prospective randomized controlled trials. Fertil Steril. 2014;102:1331–1337.e1.CrossRefGoogle Scholar
  27. 27.
    Wu HY, Yin O, Monseur B, Selter J, Collins LJ, Lau BD, et al. Lesbian, gay, bisexual, transgender content on reproductive endocrinology and infertility clinic websites. Fertil Steril. 2017;108:183–91.CrossRefGoogle Scholar
  28. 28.
    Gates GJ, Brown TNT. Marriage and same-sex couples after Obergefell. 2015.Google Scholar
  29. 29.
    Thomas S, Chung K, Paulson R, Bendikson K. Barriers to conception: LGBT individuals have worse fertility health literacy than their heterosexual female peers. Fertil Steril. 2018;109:e53–4.CrossRefGoogle Scholar
  30. 30.
    Ross LE, Steele LS, Epstein R. Service use and gaps in services for lesbian and bisexual women during donor insemination, pregnancy, and the postpartum period. J Obstet Gynaecol Canada. 2006;28:505–11.CrossRefGoogle Scholar
  31. 31.
    Light A, Wang L-F, Zeymo A, Gomez-Lobo V. Family planning and contraception use in transgender men. Contraception Elsevier. 2018;98:266–9.CrossRefGoogle Scholar
  32. 32.
    Eyler AE, Pang SC, Clark A. LGBT assisted reproduction: current practice and future possibilities.Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Sidney Kimmel Medical CollegeThomas Jefferson UniversityPhiladelphiaUSA
  2. 2.IVI-RMA New JerseyBasking RidgeUSA
  3. 3.Foundation for Embryonic CompetenceBasking RidgeUSA

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