Hindawi Publishing Corporation Obstetrics and Gynecology International Volume 2009, Article ID 584837, 11 pages doi:10.1155/2009/584837 Review Article The Potential Use of Intrauterine Insemination as a Basic Option for Infertility: A Review for Technology-Limited Medical Settings Abdelrahman M. Abdelkader and John Yeh Department of Gynecology-Obstetrics, University at Buﬀalo, The State University of New York, Buﬀalo, NY 14222, USA Correspondence should be addressed to John Yeh, jyeh@buﬀalo.edu Received 5 November 2008; Accepted 15 January 2009 Recommended by Faustino R. Pe´rez-Lo´ pez Objective. There is an asymmetric allocation of technology and other resources for infertility services. Intrauterine insemination (IUI) is a process of placing washed spermatozoa transcervically into the uterine cavity for treatment of infertility. This is a review of literature for the potential use of IUI as a basic infertility treatment in technology-limited settings. Study design. Review of articles on treatment of infertility using IUI. Results. Aspects regarding the use of IUI are reviewed, including ovarian stimulation, semen parameters associated with good outcomes, methods of sperm preparation, timing of IUI, and number of inseminations. Implications of the ﬁnding in light of the needs of low-technology medical settings are summarized. Conclusion. The reviewed evidence suggests that IUI is less expensive, less invasive, and comparably eﬀective for selected patients as a ﬁrst-line treatment for couples with unexplained or male factor infertility. Those couples may be oﬀered three to six IUI cycles in technology-limited settings. Copyright © 2009 A. M. Abdelkader and J. Yeh. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 1. Introduction Intrauterine insemination (IUI) is the therapeutic process of placing washed spermatozoa transcervically into the uterine cavity for the treatment of infertility. IUI theoretically allows a relatively higher number of motile spermatozoa to reach the oocyte [1]. The rationale for washing sperm is to remove prostaglandins, infectious agents, and antigenic proteins as well as to remove immotile spermatozoa, leucocytes, and immature germ cells. The process allows the concentration of spermatozoa in a small volume of culture media and then the concentrated spermatozoa is placed into the uterus through a transcervical catheter. The general process of artiﬁcial insemination has been used to treat a variety of physiological and psychological male and female infertility disorders such as severe hypospadius, retrograde ejaculation, impotence, and vaginismus. IUI, in the past, has been used as treatment for poor postcoital tests and immunologic infertility [2]. Currently, IUI is used to treat moderate male factor infertility and unexplained infertility. Another common use of IUI is to enhance the eﬃcacy of treatment by ovulation induction for ovulatory disorders [1]. The simple and noninvasive nature of IUI has allowed it to be performed by nurses in some centers with analogous pregnancy rates to the procedures performed by physicians [3]. Factors that may inﬂuence IUI outcome include the use of ovulation induction agents, semen analysis parameters, techniques used for sperm preparation, and the timing and number of inseminations. The resource allocation for advanced infertility services is asymmetric, with the expertise and technology more con- centrated in the larger cities and resource-rich westernized countries [4]. In this review, we address the clinical situation in the majority of the occasions, in which the infertility technology that is available for treatment of patients may be limited. Outside the technologically advanced centers, the majority of the infertility patients have fewer options for treatment. The roles for IUI and considerations for its advantageous use in this limited technology setting are considered in this manuscript. This review is divided into two parts. In the ﬁrst, the eﬃcacy and cost-eﬀectiveness of IUI are discussed, and, in the second part, the evidence is presented for the beneﬁcial clinical practice of IUI in limited technology settings.