Stimulated intra-uterine insemination is not a natural choice for the treatment of unexplained subfertility. Should the guidelines be changed?

The Royal College of Obstetricians and Gynaecologists Guidelines for the management of infertility in secondary care (1998) states that stimulated intrauterine insemination (IUI) has Grade A evidence to confirm its effective use in unexplained infertility. This paper challenges that assertion after closer assessment of the papers upon which it was based. With the current appraisal of the Guidelines as part of the 'scope' of the assessment of infertility management by the National Institute of Clinical Excellence it is important that the guidelines are indeed critically reviewed prior to their updated publication. With the emphasis on minimizing the risk of multiple pregnancies, a formal trial of stimulated IUI is called for in order to justify its continued use in this setting. Strict attention to limiting the number of follicles treated in verified unexplained subfertility is necessary to validate such a trial.