title: First line fertility treatment strategies regarding IUI and IVF require clinical evidence.
abstract: The advent of intracytoplasmic sperm injection (ICSI) has contributed to a significant growth in the delivery of assisted conception technique, such that IVF/ICSI procedures are now recommended over other interventions. Even the UK National Institute for Health Care Excellence (NICE) guidelines controversially recommends against intrauterine insemination (IUI) procedures in favour of IVF. We reflect on some of the clinical, economic, financial and ethical realities that have been used to selectively promote IVF over IUI, which is less intrusive and more patient friendly, obviates the need for embryo storage and has a global application. The evidence strongly favours IUI over IVF in selected couples and national funding strategies should include IUI treatment options. IUI, practised optimally as a first line treatment in up to six cycles, would also ease the pressures on public funds to allow the provision of up to three IVF cycles for couple who need it. Fertility clinics should also strive towards ISO15189 accreditation standards for basic semen diagnosis for male infertility used to triage ICSI treatment, to reduce the over-diagnosis of severe male factor infertility. Importantly, there is a need to develop global guidelines on inclusion policies for IVF/ICSI procedures. These suggestions are an ethically sound basis for constructing the provision of publicly funded fertility treatments.
authors.affiliation: Reproductive Medicine Unit, North Middlesex University Hospital, Old Admin Block, Sterling Way, London N18 1QX, UK Homerton Fertility Unit, Homerton University Hospital, Homerton Row, London E9 6SR, UK bahadur.g@gmail.com.
authors.forename: G
authors.initials: G
authors.lastname: Bahadur
authors.affiliation: Homerton Fertility Unit, Homerton University Hospital, Homerton Row, London E9 6SR, UK.
authors.forename: R
authors.initials: R
authors.lastname: Homburg
authors.affiliation: University College London Hospital, 250 Euston Road, London NW1 2BU, UK.
authors.forename: A
authors.initials: A
authors.lastname: Muneer
authors.affiliation: Linacre College, Oxford University, St. Cross Road, Oxford OX1 3JA, UK.
authors.forename: P
authors.initials: P
authors.lastname: Racich
authors.affiliation: Subfertility Unit, Chelsea and Westminster Hospital & West Middlesex University Hospital, Twickenham Road, Isleworth, Middlesex TW7 6AF, UK.
authors.forename: T
authors.initials: T
authors.lastname: Alangaden
authors.affiliation: Reproductive Medicine Unit, North Middlesex University Hospital, Old Admin Block, Sterling Way, London N18 1QX, UK.
authors.forename: A
authors.initials: A
authors.lastname: Al-Habib
authors.affiliation: Reproductive Medicine Unit, North Middlesex University Hospital, Old Admin Block, Sterling Way, London N18 1QX, UK.
authors.forename: S
authors.initials: S
authors.lastname: Okolo
mesh_terms: D000328:Adult; D003362:Cost-Benefit Analysis; D019317:Evidence-Based Medicine; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007246:Infertility / Q000628:therapy*; D008297:Male; D017410:Practice Guidelines as Topic; D027724:Reproductive Techniques, Assisted / Q000191:economics* / Q000941:ethics
keywords: IVF; NICE guideline; economics; ethics; first line treatment; intrauterine insemination; male infertility