{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T12:27:27Z","timestamp":1793190447700,"version":"4.5.0"},"reference-count":30,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2020,3,16]],"date-time":"2020-03-16T00:00:00Z","timestamp":1584316800000},"content-version":"unspecified","delay-in-days":15,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2020,2,13]]},"published-print":{"date-parts":[[2020,3]]},"abstract":"<jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>To compare success rates, associated risks and cost-effectiveness between intrauterine insemination (IUI) and in vitro fertilisation (IVF).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Design<\/jats:title>\n                  <jats:p>Retrospective observational study.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Setting<\/jats:title>\n                  <jats:p>The UK from 2012 to 2016.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Participants<\/jats:title>\n                  <jats:p>Data from Human Fertilisation and Embryology Authority\u2019s freedom of information request for 2012\u20132016 for IVF\/ICSI (intracytoplasmic sperm injection)and IUI as practiced in 319 105 IVF\/ICSI and 30 669 IUI cycles. Direct-cost calculations for maternal and neonatal expenditure per live birth (LB) was constructed using the cost of multiple birth model, with inflation-adjusted Bank of England index-linked data. A second direct-cost analysis evaluating the incremental cost-effective ratio (ICER) was modelled using the 2016 national mean (baseline) IVF and IUI success rates.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Outcome measures<\/jats:title>\n                  <jats:p>LB, risks from IVF and IUI, and costs to gain 1 LB.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>This largest comprehensive analysis integrating success, risks and costs at a national level shows IUI is safer and more cost-effective than IVF treatment.<\/jats:p>\n                  <jats:p>IVF LB\/cycle success was significantly better than IUI at 26.96% versus 11.49% (p&lt;0.001) but the IUI success is much closer to IVF at 2.35:1, than previously considered. IVF remains a significant source of multiple gestation pregnancy (MGP) compared with IUI (RR (Relative Risk): 1.45 (1.31 to 1.60), p&lt;0.001) as was the rate of twins (RR: 1.58, p&lt;0.001).<\/jats:p>\n                  <jats:p>In 2016, IVF maternal and neonatal cost was \u00a3115 082 017 compared with \u00a32 940 196 for IUI and this MGP-related perinatal cost is absorbed by the National Health Services. At baseline tariffs and success rates IUI was \u00a342 558 cheaper than IVF to deliver 1LB with enhanced benefits with small improvements in IUI. Reliable levels of IVF-related MGP, OHSS (ovarian hyperstimulation syndrome), fetal reductions and terminations are revealed.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>IUI success rates are much closer to IVF than previously reported, more cost-effective in delivering 1 LB, and associated with lower risk of complications for maternal and neonatal complications. It is prudent to offer IUI before IVF nationally.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjopen-2019-034566","type":"journal-article","created":{"date-parts":[[2020,3,17]],"date-time":"2020-03-17T05:09:26Z","timestamp":1584421766000},"page":"e034566","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":56,"title":["Observational retrospective study of UK national success, risks and costs for 319,105 IVF\/ICSI and 30,669 IUI treatment cycles"],"prefix":"10.1136","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0136-9278","authenticated-orcid":false,"given":"Gulam","family":"Bahadur","sequence":"first","affiliation":[{"name":"Reproductive Medicine Clinic, North Middlesex University Hospital NHS Trust, London, N18 1QX, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roy","family":"Homburg","sequence":"additional","affiliation":[{"name":"Homerton Fertility Unit, Homerton University Hospital, Homerton Row, London E9 6SR, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Judith E","family":"Bosmans","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Judith A F","family":"Huirne","sequence":"additional","affiliation":[{"name":"Research Institute Reproduction and development, University Medical Centers Amsterdam, location VUmc and AMC, De Boelelaan 1081, 1081 HV Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Hinstridge","sequence":"additional","affiliation":[{"name":"Reproductive Medicine Clinic, North Middlesex University Hospital NHS Trust, London, N18 1QX, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kanna","family":"Jayaprakasan","sequence":"additional","affiliation":[{"name":"University Hospitals of Derby and Burton NHS Trust, Royal Derby Hospital, Derby, Derby, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Racich","sequence":"additional","affiliation":[{"name":"Linacre College, Oxford University, St. Cross Road, Oxford, OX13JA, Oxfordshire, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rakib","family":"Alam","sequence":"additional","affiliation":[{"name":"Reproductive Medicine Clinic, North Middlesex University Hospital NHS Trust, London, N18 1QX, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ioannis","family":"Karapanos","sequence":"additional","affiliation":[{"name":"Reproductive Medicine Clinic, North Middlesex University Hospital NHS Trust, London, N18 1QX, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Afeeza","family":"Illahibuccus","sequence":"additional","affiliation":[{"name":"Reproductive Medicine Clinic, North Middlesex University Hospital NHS Trust, London, N18 1QX, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ansam","family":"Al-Habib","sequence":"additional","affiliation":[{"name":"Reproductive Medicine Clinic, North Middlesex University Hospital NHS Trust, London, N18 1QX, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0925-7737","authenticated-orcid":false,"given":"Eric","family":"Jauniaux","sequence":"additional","affiliation":[{"name":"EGA Institute for Womens Health, Faculty of Population Health Science, University College London, London, WC1E 6HX, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2020,3,16]]},"reference":[{"key":"2025101813492847000_10.3.e034566.1","unstructured":"HFEA Jan . 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