Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2018 Jan 25;1(1):CD000317.
doi: 10.1002/14651858.CD000317.pub4.

Intrauterine insemination versus intracervical insemination in donor sperm treatment

Petronella Al Kop  1 , Monique H Mochtar, Paul A O'Brien, Fulco Van der Veen, Madelon van Wely
Affiliations
Comparative Study

Intrauterine insemination versus intracervical insemination in donor sperm treatment

Petronella Al Kop et al. Cochrane Database Syst Rev. .

Abstract

Background: The first-line treatment in donor sperm treatment consists of inseminations that can be done by intrauterine insemination (IUI) or by intracervical insemination (ICI).

Objectives: To compare the effectiveness and safety of intrauterine insemination (IUI) and intracervical insemination (ICI) in women who start donor sperm treatment.

Search methods: We searched the Cochrane Gynaecology and Fertility Group Trials Register, CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL in October 2016, checked references of relevant studies, and contacted study authors and experts in the field to identify additional studies. We searched PubMed, Google Scholar, the Grey literature, and five trials registers on 15 December 2017.

Selection criteria: We included randomised controlled trials (RCTs) reporting on IUI versus ICI in natural cycles or with ovarian stimulation, and RCTs comparing different cointerventions in IUI and ICI. We included cross-over studies if pre-cross-over data were available.

Data collection and analysis: We used standard methodological procedures recommended by Cochrane. We collected data on primary outcomes of live birth and multiple pregnancy rates, and on secondary outcomes of clinical pregnancy, miscarriage, and cancellation rates.

Main results: We included six RCTs (708 women analysed) on ICI and IUI in donor sperm treatment. Two studies compared IUI and ICI in natural cycles, two studies compared IUI and ICI in gonadotrophin-stimulated cycles, and two studies compared timing of IUI and ICI. There was very low-quality evidence; the main limitations were risk of bias due to poor reporting of study methods, and serious imprecision.IUI versus ICI in natural cyclesThere was insufficient evidence to determine whether there was any clear difference in live birth rate between IUI and ICI in natural cycles (odds ratio (OR) 3.24, 95% confidence interval (CI) 0.12 to 87.13; 1 RCT, 26 women; very low-quality evidence). There was only one live birth in this study (in the IUI group). IUI resulted in higher clinical pregnancy rates (OR 6.18, 95% CI 1.91 to 20.03; 2 RCTs, 76 women; I² = 48%; very low-quality evidence).No multiple pregnancies or miscarriages occurred in this study.IUI versus ICI in gonadotrophin-stimulated cyclesThere was insufficient evidence to determine whether there was any clear difference in live birth rate between IUI and ICI in gonadotrophin-stimulated cycles (OR 2.55, 95% CI 0.72 to 8.96; 1 RCT, 43 women; very low-quality evidence). This suggested that if the chance of a live birth following ICI in gonadotrophin-stimulated cycles was assumed to be 30%, the chance following IUI in gonadotrophin-stimulated cycles would be between 24% and 80%. IUI may result in higher clinical pregnancy rates than ICI (OR 2.83, 95% CI 1.38 to 5.78; 2 RCTs, 131 women; I² = 0%; very low-quality evidence). IUI may be associated with higher multiple pregnancy rates than ICI (OR 2.77, 95% CI 1.00 to 7.69; 2 RCTs, 131 women; I² = 0%; very low-quality evidence). This suggested that if the risk of multiple pregnancy following ICI in gonadotrophin-stimulated cycles was assumed to be 10%, the risk following IUI would be between 10% and 46%.We found insufficient evidence to determine whether there was any clear difference between the groups in miscarriage rates in gonadotrophin-stimulated cycles (OR 1.97, 95% CI 0.43 to 9.04; 2 RCTs, overall 67 pregnancies; I² = 50%; very low-quality evidence).Timing of IUI and ICIWe found no studies that reported on live birth rates.We found a higher clinical pregnancy rate when IUI was timed one day after a rise in blood levels of luteinising hormone (LH) compared to IUI two days after a rise in blood levels of LH (OR 2.00, 95% CI 1.14 to 3.53; 1 RCT, 351 women; low-quality evidence). We found insufficient evidence to determine whether there was any clear difference in clinical pregnancy rates between ICI timed after a rise in urinary levels of LH versus a rise in basal temperature plus cervical mucus scores (OR 1.31, 95% CI 0.42 to 4.11; 1 RCT, 56 women; very low-quality evidence).Neither of these studies reported multiple pregnancy or miscarriage rates as outcomes.

Authors' conclusions: There was insufficient evidence to determine whether there was a clear difference in live birth rates between IUI and ICI in natural or gonadotrophin-stimulated cycles in women who started with donor sperm treatment. There was insufficient evidence available for the effect of timing of IUI or ICI on live birth rates. Very low-quality data suggested that in gonadotrophin-stimulated cycles, ICI may be associated with a higher clinical pregnancy rate than IUI, but also with a higher risk of multiple pregnancy rate. We concluded that the current evidence was too limited to choose between IUI or ICI, in natural cycles or with ovarian stimulation, in donor sperm treatment.

PubMed Disclaimer

Conflict of interest statement

Femke PAL Kop, Madelon van Wely, Monique H. Mochtar, and Fulco van der Veen are conducting an RCT on ICI versus IUI in natural cycles in donor sperm treatment.

Figures

1
1
Study flow diagram
2
2
'Risk of bias' summary: review authors' judgements about each risk of bias domain for each included study
3
3
'Risk of bias' graph: review authors' judgements about each risk of bias domain presented as percentages across all included studies
4
4
Forest plot of comparison: 1 Intrauterine insemination (IUI) versus intracervical insemination (ICI), outcome: 1.1 Live birth rate.
5
5
Forest plot of comparison: 1 Intrauterine insemination (IUI) versus intracervical insemination (ICI), outcome: 1.2 Multiple pregnancy rate.
6
6
Forest plot of comparison: 1 Intrauterine insemination (IUI) versus intracervical insemination (ICI), outcome: 1.3 Clinical pregnancy rate
7
7
Forest plot of comparison: 2 Timing of intrauterine insemination (IUI) with donor sperm: luteinising hormone (LH) + 1 day versus LH + 2 days, outcome: 2.3 Clinical pregnancy rate
8
8
Forest plot of comparison: 3 Timing of intracervical insemination (ICI) with donor sperm: urinary luteinising hormone (LH) test versus temperature curve and cervical mucus score, outcome: 3.2 Clinical pregnancy rate
1.1
1.1. Analysis
Comparison 1 Intrauterine insemination (IUI) versus intracervical insemination (ICI), Outcome 1 Live birth rate.
1.2
1.2. Analysis
Comparison 1 Intrauterine insemination (IUI) versus intracervical insemination (ICI), Outcome 2 Multiple pregnancy rate.
1.3
1.3. Analysis
Comparison 1 Intrauterine insemination (IUI) versus intracervical insemination (ICI), Outcome 3 Clinical pregnancy rate.
1.4
1.4. Analysis
Comparison 1 Intrauterine insemination (IUI) versus intracervical insemination (ICI), Outcome 4 Miscarriage rate.
2.1
2.1. Analysis
Comparison 2 Timing of intrauterine insemination (IUI) with donor sperm: luteinising hormone (LH) + 1 day versus LH + 2 days, Outcome 1 Live birth rate.
2.2
2.2. Analysis
Comparison 2 Timing of intrauterine insemination (IUI) with donor sperm: luteinising hormone (LH) + 1 day versus LH + 2 days, Outcome 2 Multiple pregnancy rate.
2.3
2.3. Analysis
Comparison 2 Timing of intrauterine insemination (IUI) with donor sperm: luteinising hormone (LH) + 1 day versus LH + 2 days, Outcome 3 Clinical pregnancy rate.
3.1
3.1. Analysis
Comparison 3 Timing of intracervical insemination (ICI) with donor sperm: urinary luteinising hormone (LH) test versus temperature curve and cervical mucus score, Outcome 1 Multiple pregnancy rate.
3.2
3.2. Analysis
Comparison 3 Timing of intracervical insemination (ICI) with donor sperm: urinary luteinising hormone (LH) test versus temperature curve and cervical mucus score, Outcome 2 Clinical pregnancy rate.
See this image and copyright information in PMC

Update of

References

References to studies included in this review

Blockeel 2014 {published data only}
    1. Blockeel C, Knez J, Polyzos NP, Vos M, Camus M, Tournaye H. Should an intrauterine insemination with donor semen be performed 1 or 2 days after the spontaneous LH rise? A prospective RCT. Human Reproduction (Oxford, England) April 2014;29(4):697‐703. - PubMed
Hurd 1993 {published and unpublished data}
    1. Hurd WW, Randolph JF Jr, Ansbacher R, Menge AC, Ohl DA, Brown AN. Comparison of intracervical, intrauterine, and intratubal techniques for donor insemination. Fertility and Sterility 1993;59(2):339‐42. - PubMed
Matorras 1996 {published data only}
    1. Matorras R, Gorostiaga A, Diez J, Corcostegui B, Pijoan J, Ramon O, et al. Intrauterine insemination with frozen sperm increases pregnancy rates in donor insemination cycles under gonadotropin stimulation. Fertility and Sterility 1996;65:620‐5. - PubMed
Patton 1992 {published data only}
    1. Patton PE, Burry KA, Thurmond A, Novy MJ, Wolf DP. Intrauterine insemination outperforms intracervical insemination in a randomized, controlled study with frozen, donor semen. Fertility and Sterility 1992;57(3):559‐64. - PubMed
Robinson 1992 {published data only}
    1. Robinson J, Lockwood G, Dalton J, Franklin P, Farr M, Barlow D. A randomized prospective study to assess the effect of use of home urinary luteinizing hormone detection on the efficiency of the donor insemination. Human Reproduction 1992; Vol. 7:63‐5. - PubMed
Wainer 1995 {published data only}
    1. Wainer R, Merlet F, Ducot B, Bailly M, Tribalat S, Lombroso R. Prospective randomized comparison of intrauterine and intracervical insemination with donor spermatozoa. Human Reproduction 1995;10(11):2919‐22. - PubMed

References to studies excluded from this review

Alexander 1994 {published data only}
    1. Alexander C, Lafferty A, Smith C, McNally W, Ralston C, Jamison M, et al. Treatment of male infertility: a comparison of DI and IUID. Abstracts of 2nd International Meeting of the BFS, 1 July 1994. Glasgow, 1994; Vol. Abstract number FC13.
Byrd 1990 {published data only}
    1. Byrd W, Bradshaw K, Carr B, Edman C, Odom J, Ackerman G. A prospective randomized study of pregnancy rates following intrauterine and intracervical insemination using frozen donor sperm. Fertility and Sterility 1990;53:521‐7. - PubMed
Carroll 2001 {published data only}
    1. Carroll N, Palmer JR. A comparison of intrauterine versus intracervical insemination in fertile single women. Fertility and Sterility 2001;75(4):656‐60. - PubMed
Coulson 1996 {published data only}
    1. Coulson C, McLhlin EA, Harris S, Ford WCL, Hull MGR. Randomized controlled trial of cervical cap with intracervical reservoir versus standard intracervical injection to inseminate cryopreserved donor semen. Human Reproduction 1996; Vol. 11:84‐7. - PubMed
Flierman 1997 {published data only}
    1. Flierman PA, Hogerzeil HV, Hemrika DJ. A prospective, randomized, cross‐over comparison of two methods of artificial insemination by donor on the incidence of conception: intracervical insemination by straw versus cervical cap. Human Reproduction 1997; Vol. 12, issue 9:1945‐8. - PubMed
Le Lannou 1989 {published data only}
    1. Lannou D, Laroche M, Ommi‐Bie N, Gastard E, Gueho A, Sevene L, et al. Interest in intra‐uterine insemination in an AID program [Intérêts des inséminations intra‐utérines dans un programme d'IAD]. Contraception Fertilité Sexualité 1989;17:665‐6.
Patton 1990 {published data only}
    1. Patton P, Burry K, Novy M, Wold D. A comparative evaluation of intracervical and intrauterine routes in donor therapeutic insemination. Human Reproduction 1990;5:263‐5. - PubMed
Peters 1993 {published data only}
    1. Peters A, Hecht B, Wentz A, Jeyendran R. Comparison of the methods of artificial insemination on the incidence of conception in single unmarried women. Fertility and Sterility 1993;59:121‐4. - PubMed
Pistorius 1996 {published data only}
    1. Pistorius LR, Kruger TF, Villier A, Merwe JP. A comparative study using prepared and unprepared frozen semen for donor insemination. Archives of Andrology 1993;36:81‐6. - PubMed
Ract 1992 {published data only}
    1. Ract V, Barthelemy C, Lanoue C, Lecomte C, Lansac J, Royere D. Comparison between intracervical and intrauterine insemination using frozen donor sperm beyond the 6th cycle [Comparaison entre inséminations intracervicales et intra‐utérines en IAD au‐delà du 6e cycles]. Contraception Fertilite Sexualite 1992;20:799‐800.
Urry 1988 {published data only}
    1. Urry R, Middleton R, Jones K, Poulson M, Worley R, Keye W. Artificial insemination: a comparison of pregnancy rates with intrauterine versus cervical insemination and washed sperm versus swim‐up sperm preparations. Fertility and Sterility 1988;49:1036‐8. - PubMed
Walker 1993 {published and unpublished data}
    1. Walker D, Kennedy C, Clarke T, Skelton J. A study to compare transcervical donor insemination and superovulated donor intra‐uterine insemination. Human Reproduction 1993;8(Suppl 1):151.
Williams 1995 {published data only}
    1. Williams D, Moley K, Cholewa C, Odem R, Willand J, Gast M. Does intrauterine insemination offer an advantage to cervical cap insemination in a donor insemination program?. Fertility and Sterility 1995;63:295‐8. - PubMed

References to ongoing studies

NTR4462 {unpublished data only}
    1. Artificial insemination with donor sperm: intrauterine or intracervical insemination?. Ongoing study 01 February 2014.

Additional references

ARSM 2012
    1. American Society for Reproductive Medicine. Recommendations for gamete and embryo donation: a committee opinion. Fertility and Sterility October 2012;99(1):47‐62. - PubMed
Boomsma 2007
    1. Boomsma CM, Heineman MJ, Cohlen BJ, Farquhar C. Semen preparation techniques for intrauterine insemination. Cochrane Database of Systematic Reviews 2007, Issue 4. [DOI: 10.1002/14651858.CD004507] - DOI - PubMed
Cantineau 2014
    1. Cantineau AE, Janssen MJ, Cohlen BJ, Allersma T. Synchronised approach for intrauterine insemination in subfertile couples. Cochrane Database of Systematic Reviews 2014, Issue 12. [DOI: 10.1002/14651858.CD006942.pub3] - DOI - PMC - PubMed
Fauser 2005
    1. Fauser BCJM, Devroey P, Macklon NS. Multiple birth resulting from ovarian stimulation for subfertility treatment. Lancet 2005;365:1807‐16. - PubMed
Goldberg 1999
    1. Goldberg JM, Mascha E, Falcone T, Attaran M. Comparison of intrauterine and intracervical insemination with frozen donor sperm: a meta‐analysis. Fertility and Sterility 1999;72(5):792‐5. - PubMed
GRADEpro GDT [Computer program]
    1. McMaster University (developed by Evidence Prime). GRADEpro GDT. Version accessed on 15 December 2017. Hamilton (ON): McMaster University (developed by Evidence Prime), 2015.
Higgins 2011
    1. Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from handbook.cochrane.org.
Insler 1977
    1. Insler V. The evaluation and treatment of cervical mucus diseases leading to infertility. Advances in Experimental Medicine and Biology 1977;89:477‐88. - PubMed
Liebaers 1998
    1. Liebaers I, Sermon K, Staessen C, Joris H, Lissens W, Assche E, et al. Clinical experience with preimplantation genetic diagnosis and intracytoplasmic sperm injection. Human Reproduction 1998;1:186‐95. - PubMed
NICE 2013
    1. National Institute for Health and Care Excellence (NICE). Fertility: assessment and treatment for people with fertility problems. NICE Clinical Guidelines, No. 156 (updated September 2017). Available at www.nice.org.uk/guidance/cg156 (accessed on several occasions during 2016 and 2017).
Palermo 1992
    1. Palermo G, Joris H, Devroey P, Steirteghemer AC. Pregnancies after intracytoplasmic injection of single spermatozoön into an oocyte. Lancet 1992;4:17‐8. - PubMed
Review Manager 2014 [Computer program]
    1. Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager 5 (RevMan 5). Version 5.3. Copenhagen: Nordic Cochrane Centre, The Cochrane Collaboration, 2014.
Semprini 1992
    1. Semprini AE, Levi‐Setti P, Bozzo M, Ravizza M, Taglioretti A, Sulpizio P, et al. Insemination of HIV‐negative women with processed semen of HIV‐positive partners. Lancet 1992;340:1317‐9. - PubMed
Seymour 1941
    1. Seymour FI, Koerner A. Artificial insemination, present status in the USA, as shown by a recent survey. JAMA 1941;116:2747.
Silber 1996
    1. Silber SJ, Steirteghem AC, Nagy Z, Liu J, Tournaye H, Devroey P. Normal pregnancies resulting from testicular sperm extraction and intracytoplasmic sperm injection for azoospermia due to maturation arrest. Fertility and Sterility 1996;66:110‐7. - PubMed
Subak 1992
    1. Subak LL, Adamson D, Boltz NL. Therapeutic donor insemination: A prospective randomized trial of fresh versus frozen sperm. American Journal of Obstetrics & Gynecology 1992;166:1597‐04. - PubMed
Tournaye 1994
    1. Tournaye H, Devroey P, Liu J, Nagy Z, Lissens W, Steirteghem A. Microsurgical epididymal sperm aspiration and intracytoplasmic sperm injection: a new effective approach to infertility as a result of congenital bilateral absence of the vas deferens. Fertility and Sterility 1994;61:1045‐51. - PubMed
Vernaeve 2004
    1. Vernaeve V, Festré V, Baetens P, Devroey P, Steirteghem A, Tournaye H. Reproductive decisions by couples undergoing artificial insemination with donor sperm for severe male infertility: implications for medical counselling. International Journal of Andrology 2005;28:22‐6. - PubMed

References to other published versions of this review

Besselink 2008
    1. Besselink DE, Farquhar C, Kremer JAM, Marjoribanks J, O'Brien P. Cervical insemination versus intra‐uterine insemination of donor sperm for subfertility. Cochrane Database of Systematic Reviews 2008, Issue 2. [DOI: 10.1002/14651858.CD000317.pub3] - DOI - PubMed
O'Brien 1998
    1. O'Brien P, Vandekerckhove P. Intra‐uterine versus cervical insemination of donor sperm for subfertility. Cochrane Database of Systematic Reviews 1998, Issue 4. [DOI: 10.1002/14651858.CD000317] - DOI - PubMed