Intrauterine Insemination in Women with Endometriosis

Although intrauterine inseminations (IUI) with or without superovulation have been widely used in treating endometriosis-related infertility, the available studies are limited by small sample size, experimental design, and heterogenous study populations. IUI is effective in improving fertility in women with stages I–II endometriosis compared with expectant management, and, in these patients, IUI preceded by controlled ovarian hyperstimulation results in higher pregnancy rates compared with IUI alone. IUI may be less efficacious in patients with stages III–IV compared with those with stages I–II, possibly because the anatomic distortion caused by endometriosis may impair fertility. Limited data are available on the role of hormonal suppression of endometriosis before IUI, and, therefore, it cannot be recommended because the potential improvement in pregnancy rates must be balanced with the adverse effects of treatment and the delay in the treatment.