The use of intrauterine insemination in Australia and New Zealand.
BACKGROUND
There is good evidence in the literature in favour of intrauterine insemination (IUI) as the most cost-effective treatment for unexplained and moderate male factor subfertility. However there is no published data on whether this evidence is being translated into clinical practice.


METHODS
We identified fertility centres within Australia and New Zealand registered with the Reproductive Technology Accreditation Committee of the Fertility Society of Australasia. Thirty-seven of these units were then sent a postal survey to establish current clinical practice.


RESULTS
Nearly a third of centres promote IVF as first-line treatment even in the presence of patent tubes and normal semen while, when semen parameters are reduced, IUI is rarely considered. One in five (20%) units remain unconvinced of the cost-effectiveness of IUI. When IUI is used, it is virtually always combined with ovarian stimulation with marginally more units using clomiphene citrate than gonadotrophins.


CONCLUSIONS
Although it may take relatively more treatment cycles to achieve pregnancy, there are considerable advantages to the patient in terms of risk/benefit ratio and financial cost associated with IUI compared with IVF. In the current climate of evidence-based medicine, as clinicians we are obliged to translate this into our practice. It appears from our survey that in many units this is not happening.
Miskry
Tariq
T
Department of Obstetrics and Gynaecology, St George Hospital, Kogarah, NSW, Australia. miskry@hotmail.com
Chapman
Michael
M
D001315:Australia; D002996:Clomiphene / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D003625:Data Collection; D005260:Female; D005300:Fertility Agents, Female / Q000627:therapeutic use; D005307:Fertilization in Vitro; D006801:Humans; D007246:Infertility / Q000628:therapy*; D007315:Insemination, Artificial / Q000191:economics / Q000706:statistics & numerical data*; D008297:Male; D009520:New Zealand; D010062:Ovulation Induction / Q000706:statistics & numerical data; D011247:Pregnancy
D005300:Fertility Agents, Female; D002996:Clomiphene