Intrauterine insemination (IUI) as a first-line treatment in developing countries and methodological aspects that might influence IUI success

⁴ Correspondence address. E-mail: willem.ombelet{at}telenet.be It is generally accepted that intrauterine insemination (IUI)should be preferred to more invasive and expensive techniquesof assisted reproduction and be offered as a first-choice treatmentin cases of unexplained and moderate male factor subfertility.Scientific validation of this strategy is rather difficult becauseliterature is rather confusing and not conclusive. IUI is proveneasier to perform, less invasive and less expensive than othermethods of assisted reproduction. Effectivity has been documentedin controlled studies under the condition that the inseminatingmotile count exceeds more than 1 million motile spermatozoa.Risks are minimal, provided the multiple gestation incidencecan be reduced to an acceptable level and provided at leastone tube is patent. Therefore, in developing countries, reflectionon the implementation and use of IUI as a first-line treatmentfor most cases of non-tubal infertility seems mandatory. Thecosts are minimal, training is easy, quality control possibleand severe complications are almost non-existing. In cases ofunexplained infertility or combined male subfertility and ovulatorydysfunction, correction and/or ovarian stimulation with clomiphenecitrate (CC) is probably the best strategy from a cost–benefitpoint of view unless CC-resistancy has been proven in whichthe use of low-dose gonadotrophins is necessary.