Intrauterine insemination: a first-step procedure in the algorithm of male subfertility treatment.

Despite the widespread clinical use of intrauterine insemination (IUI) in the treatment of male subfertility, its therapeutic value remains unclear. The objective of this review was to determine why its efficacy has not been consistently documented in the literature and to give strong evidence supporting the therapeutic merit of ovarian stimulation/IUI in male subfertility treatment. Because (i) this technique is much easier to perform and less expensive than assisted reproduction methods, and seems to be reasonably effective in controlled studies of a male subfertility treatment, and (ii) we may expect that financial resources available for the health care of infertility patients will be limited in the future, we believe that ovarian stimulation/IUI must become the first-line treatment in most cases of male factor subfertility, provided that the multiple gestation incidence can be reduced to an acceptable level.