Which treatment option for couples with unexplained or mild male subfertility?

Assisted reproductive technologies include a range of treatment options for infertile couples, with large variations in invasiveness, side effects, and costs. With intrauterine insemination, fertilisation takes place inside the female genital tract; with in vitro fertilisation (IVF), fertilisation occurs in a culture dish. From a couple’s perspective, intrauterine insemination is a less invasive and less stressful procedure than IVF. However, lower success rates per treatment cycle and an increased risk of twin pregnancies have made fertility experts reluctant to offer intrauterine insemination as a first line treatment.

A linked study by Bensdorp and colleagues (doi:10.1136/bmj.g7771) sheds new light on the effectiveness of intrauterine insemination and also on the view that higher rates of multiple pregnancies after insemination with controlled ovarian stimulation are inevitable.1 They conducted a multicentre randomised controlled non-inferiority trial in couples with unexplained or mild male subfertility attending 17 fertility clinics in the Netherlands. Participants were randomised into three groups. Couples in one group had three cycles of IVF with single embryo transfer (plus surplus cryopreserved embryos), couples in a second group had six cycles of IVF in …