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Should intrauterine inseminations still be proposed in cases of unexplained infertility? Retrospective study and literature review

  • Gynecologic Endocrinology and Reproductive Medicine
  • Published:
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Abstract

Objective

Unexplained infertility is defined by the absence of identifiable causes of infertility. The results of randomized studies and meta-analysis regarding the treatment of unexplained infertility are discordant due to methodological problems.

Design

The aim of this study is to compare the clinical pregnancy rate per cycle (CPR/c) in IUI and IVF/ICSI in cases of unexplained infertility, according to the woman’s age group and to identify the factors which predict success.

Interventions

We performed a retrospective study in two ART centers, comparing overall clinical pregnancy, ongoing pregnancy and live birth rates in IVF/ICSI and IUI. We also compared pregnancy and birth rates according to different female age groups.

Results

855 IVF/ICSI and 804 IUI cycles were compared. We found a significant difference (p < 0.001) in the pregnancy and live birth rates per cycle between IUI and IVF/ICSI, overall and in the different female age groups, except in women aged 40 and over. The greatest chances of pregnancy with IUI are found in women with secondary unexplained infertility, during the first two cycles and with a bi-follicular response to stimulation. In IVF/ICSI, pregnancy rates are higher in women with secondary unexplained infertility, in the first two cycles, in IVF and in women receiving a transfer of two embryos regardless of the embryonic stage.

Conclusion

We recommend IVF/ICSI treatment rather than IUI for unexplained infertility (OR CPR/c 4.20 with 95% CI [3.72–4.68]). This is in accordance with NICE, which advises the use of IVF after 2 years.

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Availability of data and materials

The material contained in this manuscript has not been published, has not been submitted or is not being submitted elsewhere. The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

The authors thank Pandora James for their comments, suggestions and critical reading of the manuscript.

Funding

Not applicable.

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Authors and Affiliations

  1. ART Center, Brest University Hospital, 2 Avenue Foch, 29200, Brest, France

    Philippe Merviel, Marion Labarre, Pandora James, Sarah Bouée, Jean-Jacques Chabaud, Sylvie Roche, Hortense Drapier & Damien Beauvillard

  2. ART Center, Amiens University Hospital, Rue du Professeur Christian Cabrol, 80000, Amiens, France

    Rosalie Cabry, Florence Scheffler, Emmanuelle Lourdel, Moncef Benkhalifa & Henri Copin

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  1. Philippe Merviel
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  2. Marion Labarre
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Contributions

PM substantial contributions to the conception, design of the work, the acquisition, analysis and interpretation of data; have drafted the work or substantively revised it. ML substantial contributions to the conception, design of the work, the acquisition, analysis and interpretation of data. PJ comments, suggestions and critical reading of the manuscript. SB, J-JC, SR, RC, FS, EL the acquisition of clinical data. MB the acquisition of biological data and comments, suggestions and critical reading of the manuscript. Henri Copin (Head of the Amiens ART center), HD, DB (Head of the Brest ART center): the acquisition of biological data. Each author has approved the submitted version and have agreed both to be personally accountable for the author’s own contributions and to ensure that questions related to the accuracy or integrity of any part of the work, even ones in which the author was not personally involved, are appropriately investigated, resolved, and the resolution documented in the literature.

Corresponding author

Correspondence to Philippe Merviel.

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Conflict of interest

The authors report no conflicts of interest in relation to the present study.

Ethical approval

All the couples have signed consent to the infertility treatment. Given that the couples had already consented (non opposition) to the exploitation of their personal medical data for research purposes and in line with the French legislation on studies of routine medical care (Loi n°78–17 du 6 janvier 1978 modifiée en 2004 relative à l’informatique, aux fichiers et aux libertés: For all research involving human participants, informed consent to participate in the study should be obtained from participants (or their parent or legal guardian in the case of children under 16), approval by an independent ethics committee. This study was approved by the Brest Institutional Review Board (reference B2020CE.43).

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The consents of each couple are available in their medical record and with the corresponding author.

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Merviel, P., Labarre, M., James, P. et al. Should intrauterine inseminations still be proposed in cases of unexplained infertility? Retrospective study and literature review. Arch Gynecol Obstet 305, 1241–1254 (2022). https://doi.org/10.1007/s00404-021-06351-w

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