title: Replacing IUI with IVF for initial treatment of unexplained infertility: why this NICE recommendation is cause for concern.
abstract: The latest guidelines from the National Institute for Health and Care Excellence (NICE) for assisted conception recommend that people experiencing unexplained infertility should no longer be offered stimulated intra-uterine insemination (IUI) as a first-line treatment, but rather be directed towards IVF or alternatively be left to expectant management. NICE has acknowledged that the cited evidence leading to this decision was not sufficiently robust. As such, we are concerned that accordance with these new NICE guidelines may result in people with no identifiable cause of their infertility being prematurely referred for IVF treatment. Since IVF constitutes a more invasive and expensive treatment process, which also represents an additional and unnecessary cost pressure to the National Health Service, there is a longstanding need for a robust clinical trial to resolve the uncertainty as to whether one treatment is more appropriate than another. Until such data is available, we suggest that provision of stimulated IUI, in centres achieving a satisfactory live birth rate, represents a significant cost-saving to those commissioning fertility services, with lower risks to people treated.
authors.affiliation: a Fertility Unit, Nottingham University Hospital , Nottingham , UK ;
authors.forename: Bryan
authors.initials: B
authors.lastname: Woodward
authors.affiliation: a Fertility Unit, Nottingham University Hospital , Nottingham , UK ;
authors.forename: Mathew
authors.initials: M
authors.lastname: Tomlinson
authors.affiliation: b School of Clinical and Experimental Medicine, University of Birmingham , Birmingham , UK ;|c Birmingham Women's Hospital Centre for Human Reproductive Science , Birmingham , UK.
authors.forename: Jackson
authors.initials: J
authors.lastname: Kirkman-Brown
mesh_terms: D000328:Adult; D003362:Cost-Benefit Analysis; D005260:Female; D005307:Fertilization in Vitro / Q000009:adverse effects / Q000191:economics; D006801:Humans; D007246:Infertility / Q000209:etiology* / Q000628:therapy*; D007317:Insemination, Artificial, Homologous / Q000009:adverse effects / Q000191:economics / Q000379:methods; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D012307:Risk Factors; D006113:United Kingdom
keywords: Intrauterine insemination; in vitro fertilization; patient preferences