It is a common subject of discussion with couples having normal sperm, tubes and ovaries, and over two years of infertility, the option of insemination with or without superovulation or to an IVF treatment.
Although the studies have shown that for these couples the efficacy of three insemination cycles is equivalent to an IVF cycle, the superiority of the insemination compared to an intercourse has never been demonstrated. This led to a UK national directive by NICE which effectively abolished the insemination as a cure for unexplained infertility based mainly on Prof Bhattacharia's Cochrane review.
Certainly, the insemination provides additional functional information for the sperm but consideration should be given to its reduced effectiveness (up to 16-21% per cycle) as well as to the loss of time to complete these treatments.
In addition, IVF treatment offers additional information on the quality and the maturity of the ova that can clarify a case of apparently unexplained infertility. While in an ovulation induction for insemination we monitor the follicles without knowing their content, in the IVF treatment we know all the details about the quality and the maturity of the ova as well as the quality of the embryos.
Thus, it seems that the insemination can be offered to couples in which the woman is younger than 37 years of age both as a diagnostic tool and as an argument for facilitating the approval by the IVF committee but it should not delay the most effective solution which is the ovarian stimulation and the IVF treatment.
By Dr. Pachydakis Anasiasios, PhD
Obstetrician-Gynecologist at Embryogenesis