Evidence map›Paper›PMID 32184314›Full record

Observational studyBMJ open2020

Observational retrospective study of UK national success, risks and costs for 319,105 IVF/ICSI and 30,669 IUI treatment cycles.

Gulam Bahadur, Roy Homburg, Judith E Bosmans, Judith A F Huirne, Peter Hinstridge, Kanna Jayaprakasan, Paul Racich, Rakib Alam, Ioannis Karapanos, Afeeza Illahibuccus and 2 more

Open access · goldAbstract readComparative StudyObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in BMJ open, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 37 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
37citing papers in PubMed, 2 pooled it
18.3field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

37 citing papers in PubMed, 2 syntheses or guidelines pooled it, 70 citations in OpenAlex.

  1. Pooled it
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  6. Patient-level cost analysis of subfertility pathways in the Dutch healthcare system.The European journal of health economics : HEPAC : health economics in prevention and care · 2025
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors at 7 institutions in 4 countries.

Gulam BahadurReproductive Medicine Clinic, North Middlesex University Hospital NHS Trust, London, N18 1QX, UK bahadur.g@gmail.com.ORCID 0000-0002-0136-9278
Roy HomburgHomerton Fertility Unit, Homerton University Hospital, Homerton Row, London E9 6SR, UK.
Judith E BosmansDepartment of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, Amsterdam, The Netherlands.
Judith A F HuirneResearch Institute Reproduction and development, University Medical Centers Amsterdam, location VUmc and AMC, De Boelelaan 1081, 1081 HV Amsterdam, The Netherlands.
Peter HinstridgeReproductive Medicine Clinic, North Middlesex University Hospital NHS Trust, London, N18 1QX, UK.
Kanna JayaprakasanUniversity Hospitals of Derby and Burton NHS Trust, Royal Derby Hospital, Derby, Derby, UK.
Paul RacichLinacre College, Oxford University, St. Cross Road, Oxford, OX13JA, Oxfordshire, UK.
Rakib AlamReproductive Medicine Clinic, North Middlesex University Hospital NHS Trust, London, N18 1QX, UK.
Ioannis KarapanosReproductive Medicine Clinic, North Middlesex University Hospital NHS Trust, London, N18 1QX, UK.
Afeeza IllahibuccusReproductive Medicine Clinic, North Middlesex University Hospital NHS Trust, London, N18 1QX, UK.
Ansam Al-HabibReproductive Medicine Clinic, North Middlesex University Hospital NHS Trust, London, N18 1QX, UK.
Eric JauniauxEGA Institute for Womens Health, Faculty of Population Health Science, University College London, London, WC1E 6HX, UK.ORCID 0000-0003-0925-7737
Seattle Reproductive Medicine · USAmsterdam University Medical Centers · NLDepartment of Medical Sciences · BYHomerton University Hospital · GBRoyal Derby Hospital · GBUniversity College London · GBUniversity of Oxford · GB

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveTo compare success rates, associated risks and cost-effectiveness between intrauterine insemination (IUI) and in vitro fertilisation (IVF).

designRetrospective observational study.

settingThe UK from 2012 to 2016.

participantsData from Human Fertilisation and Embryology Authority's freedom of information request for 2012-2016 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. OUTCOME MEASURES: LB, risks from IVF and IUI, and costs to gain 1 LB.

resultsThis largest comprehensive analysis integrating success, risks and costs at a national level shows IUI is safer and more cost-effective than IVF treatment.IVF LB/cycle success was significantly better than IUI at 26.96% versus 11.49% (p<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<0.001) as was the rate of twins (RR: 1.58, p<0.001).In 2016, IVF maternal and neonatal cost was £115 082 017 compared with £2 940 196 for IUI and this MGP-related perinatal cost is absorbed by the National Health Services. At baseline tariffs and success rates IUI was £42 558 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.

conclusionIUI 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.

Indexed as

Cost-Benefit AnalysisFertilization in VitroInsemination, ArtificialAdultFemaleHealth Care CostsHumansPregnancyRetrospective StudiesSperm Injections, IntracytoplasmicUnited Kingdomcost efficiencyIUIIVFrisksstakeholderssuccess

Identifiers

PMID32184314
PMCPMC7076239
OpenAlexW3012303981

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.