IUI - managing the risks

According to NICE guidelines, the multiple birth rates for a group of patients undergoing stimulated intrauterine insemination (IUI) in a study in the US were:

• 22% twins
• 4% triplets
• 3% quadruplets

There were no multiple births in a similar unstimulated group. See the NICE website for more information.

What is the official guidance?

NICE Guidelines (Clinical Guideline 11, February 2004, para 1) on IUI and multiple births state that:

• Where intrauterine insemination is used to manage male factor fertility problems, ovarian stimulation should not be offered because it is no more clinically effective than unstimulated intrauterine insemination and it carries a risk of multiple pregnancy.
• Where intrauterine insemination is used to manage unexplained fertility problems, both stimulated and unstimulated intrauterine insemination are more effective than no treatment.
•  However, ovarian stimulation should not be offered, even though it is associated with higher pregnancy rates than unstimulated intrauterine insemination, because it carries a risk of multiple pregnancy.
• Where intrauterine insemination is undertaken, single rather than double insemination should be offered. 

Minimising the risks

To balance the risks of multiple pregnancy with the chance of a positive outcome, the following approach is recommended: 

• It is important to explain to patients the risks of multiple pregnancy associated with stimulated IUI and to give details of the types of problems that accompany multiple pregnancies and multiple births (see What are the risks?).
• Follow up with written information (brochures, leaflets, etc).
• For couples where male factor fertility problems are the suspected cause of infertility, or in cases of unexplained fertility problems, to minimise the risk of multiple pregnancy, IUI should not be coupled with ovarian stimulation.
• It is appropriate to offer stimulated IUI in cases of minimal or mild endometriosis.