Intrauterine insemination (IUI) is routinely adopted by many couples, despite the advances in IVF and emergence of other infertility therapies, due to minimal drug use during treatment, low cost, and occurrence of fertilization in the fallopian tube similar to natural conception. A new multicenter randomized clinical trial published in the British Medical Journal recommends 15 minutes of immobilization after the standard IUI procedure as it can improve the ongoing pregnancy and live birth rates.

The study, carried out by Inge M Custers, at the Centre for Reproductive Medicine, Department of Obstetrics and Gynaecology, Academic Medical Centre, Amsterdam, Netherlands, and coworkers, compared the effectiveness of 15-minute immobilization with immediate mobilization, following the standard IUI procedure. The trial involved 391 couples opting for the procedure due to unexplained infertility, cervical factor infertility, or male subfertility. Among the patients, 199 couples underwent 15 minutes of immobilization in supine position after performing the insemination in lithotomy position in a Trendelenburg tilt, while the remaining 192 controls were mobilized immediately after the IUI cycles. The study findings obtained were as follows:

Earlier, Saleh et al (Fertility and Sterility, 2000) recommended adding 10 minutes bed rest following the intrauterine insemination procedure in order to improve the rate of pregnancy. However, several other studies have suggested that the sperm’s migration to the fertilization site is not influenced by the position adopted by the patient after undergoing the IUI procedure.

Although the recent study proposes the positive effect of immobilization on IUI outcome, the rationale behind the association is still unclear. Some of the speculated reasons proposed by previous studies are as follows:
• Immediate mobilization might result in the leakage of the inseminated fluid along with spermatozoa out of the uterus
• The migration of the processed sperms towards and up the fallopian tubes may take longer in artificial insemination than in normal coitus

IUI is recommended by the National Institute for Health and Clinical Excellence (NICE) as an effective treatment option for patients suffering from unexplained infertility, mild male factor infertility, and mild endometriosis. Recently, the technique gained acceptance to the list of procedures licensed by UK’s independent regulator, the Human Fertilization and Embryology Authority (HFEA). However, a recent study by the ESHRE Capri Workshop Group (Human Reproduction Update, 2009) concluded on the IUI procedure as a treatment strategy that provides modest results on ovarian stimulation, and as a poor alternative to IVF. The group also highlighted the need for more clinical trials to evaluate the efficacy of IUI with mild stimulation, and to develop a consensus on the order of IUI and other assisted reproduction methods.

References

1. Custers IM, Flierman PA, Maas P, et al. Immobilisation versus immediate mobilisation after intrauterine insemination: randomised controlled trial. BMJ. 2009 Oct 29;339:b4080. doi: 10.1136/bmj.b4080.

2. Saleh A, Tan SL, Biljan MM, Tulandi T. A randomized study of the effect of 10 minutes of bed rest after intrauterine insemination. Fertil Steril. 2000 Sep;74(3):509-11.

3. ESHRE Capri Workshop Group. Intrauterine insemination. Hum Reprod Update. 2009 May-Jun;15(3):265-77.