IUI and cumulative live birth rate.

Background One in six couples in Australia experiences fertility problems1. Randomized clinical trials have confirmed the effectiveness of intrauterine insemination (IUI) as compared to no treatment and IVF. However, IUI, while much less expensive than IVF, is used on a limited scale in Australia. Aim To study, in women with unexplained subfertility, the cumulative chance of conception leading to live birth from intrauterine insemination (IUI). Method We performed a retrospective cohort analysis among consecutive couples with unexplained subfertility in a single fertility centre from January 2013 to December 2017. Couples were followed from the start of IUI until live birth (registered at the moment of conception), or the last cycle of IUI (up to 8 cycles). We constructed Kaplan Meier curves and estimated cumulative live birth rates with IUI in terms of days since IUI and number of cycles. Results In total, 574 couples with unexplained subfertility underwent 1313 cycles of IUI. The median age of women included in this study was 35 (range 21 to 45). Of all the women in the study, 11.71% of them had previous pregnancy over 20 weeks gestation, whereas the remainder of 88.29% women did not. The cumulative chance of conception leading to live birth within 90 and 180 days from IUI treatment was 18% [95% confidence interval (CI) 14%-23%] and 24% (95% CI 18%-31%), respectively. Similarly, the cumulative chance to have a live birth by undergoing three and five cycles of IUI was 19% (95% CI 15%-24%) and 24% (95% CI 17%-35%), respectively. The chance did not further increase with more cycles of IUI performed. Conclusion Couples with unexplained subfertility have a reasonable cumulative chance of live birth by having five cycles of IUI within 180 days. The value of this treatment in treating unexplained subfertility, with low cost and minor safety concerns, should be reconsidered in Australia.