Donor Intrauterine Insemination Equally Effective for Heterosexual Couples, Single Women, Lesbians

By Will Boggs MD

December 26, 2019

NEW YORK (Reuters Health) - Rates of live birth following donor intrauterine insemination (IUI) are similar for heterosexual couples, single women, and lesbian couples, according to a retrospective study.

Data on the clinical outcome of donor IUI in single women and lesbian couples are limited, but their lack of diagnosis of infertility suggests that they might fare at least as well as heterosexual couples without male factor infertility.

Dr. Sergio Reis Soares from IVIRMA Lisbon, in Portugal, and colleagues investigated live birth rates, multiple pregnancy rates, and miscarriage rates after more than 7,000 IUI treatment cycles in a total of 3,807 patients, including 1,167 donor IUI cycles in 528 heterosexual couples, 2,839 cycles in 1,402 single women and 1,312 cycles in 585 lesbian couples, and 1,910 cycles of autologous IUI in 1,292 heterosexual couples.

Live-birth rates were similar after donor IUI in heterosexual couples (17.7%), lesbian couples (16.2%), and single women (12.4%). However, live-birth rates among heterosexual couples following autologous IUI (i.e., with the husband's semen) were significantly lower (10.5%), the researchers report in Human Reproduction.

Cumulative live-birth rates after four IUI attempts among women 37 years and younger were significantly lower after autologous IUI in heterosexual couples (35.5%) than after donor IUI in heterosexual couples (56.8%), single women (50.2%), and lesbian couples (53.9%), without significant differences among the donor IUI groups.

After adjusting for other factors, the odds of live birth were 82.2% higher among heterosexual couples undergoing donor IUI, 63.7% higher among single women, and 83.9% higher among lesbian couples compared with the odds of live birth among heterosexual couples undergoing autologous IUI (all P<0.001).

More advanced age and low ovarian reserve were also independently associated with lower live-birth rates.

Multiple pregnancy rates and miscarriage rates did not differ significantly between the donor IUI groups and the autologous IUI group.

"This study provides, for the first time, sound evidence of equivalent clinical outcome in the three populational groups treated with donor semen, when potential sources of bias are properly controlled for," the authors conclude.

The authors note that their data "were generated from treatments in which gonadotropins were nearly always the drug of choice, which is not a universal approach."

Dr. Brent Monseur of the Sidney Kimmel Medical College, Thomas Jefferson University, in Philadelphia, who recently found similar benefits of single and double IUI among lesbian and single women seeking to conceive, told Reuters Health by email, "By using a large sample size, controlling for confounders, and investigating live-birth-rate outcomes, the present study adds high-quality data to the growing body of fertility literature focused on single and lesbian individuals."

"Treatment with gonadotropins and IUI is rarely offered as first line of treatment for single or lesbian women in the U.S., given the increase in cost and very high risk of multiple pregnancy," he said. "These are essentially normal women that just need inseminations with donor sperm to conceive; therefore, more conservative treatments should be recommended."

"As this group, as well as the LGBTQ population-at-large, uses assisted-reproductive technologies with increasing frequency, it is imperative that clinicians continue to optimize care using evidence-based protocols tailored to patients' specific needs," said Dr. Monseur, who was not involved in the study.

Dr. Claudio Benadiva of The Center for Advanced Reproductive Services at UConn Health, in Farmington, Connecticut, who has evaluated utilization of fertility treatment and reproductive choices by lesbian couples, told Reuters Health by email, "We found that it takes a mean of 3 cycles to achieve a live birth with IUI, and 1.7 cycles with IVF. For lesbian couples, we also found that their likelihood of success is improved if both partners attempt conception."

"The success of IUI in women over 40 was <7%," he said. "Those women should move on to IVF more expeditiously and not waste time with IUIs."

Referring to the new research, Dr. Benadiva added, "This paper (as well as ours) showed that most patients conceived with IUI after the first 3-4 cycles. Therefore, some health insurances' requirement that single or lesbian women should attempt to conceive for >12 cycles to fit the criteria for 'infertile' are unfounded and should be changed."

Dr. Soares did not respond to a request for comments.

SOURCE: Human Reproduction, online November 6, 2019.