Alternatives to in vitro fertilization

There have been concerns on the potential overuse of in vitro fertilization (IVF) in view of the lack of evidence on effectiveness in certain populations, potential short and long-term safety risks, and economic considerations. On the other hand, the use of alternatives to IVF seems to be underappreciated in clinical practice as well as research. In this review, we summarized the up-to-date evidence on the effectiveness, safety as well as cost-effectiveness of different alternatives to IVF, including expectant management, intrauterine insemination, tubal flushing, in vitro maturation as well as intravaginal culture. We also discussed the trend of IVF use over the last decade and the available tiers of service because of intravaginal culture, and revisited the roles of different alternatives to IVF in modern reproductive medicine from both clinical and research perspectives. (Fertil Steril & REG; 2023;120:483-93.& COPY;2023 by American Society for Reproductive Medicine.)

Automated summary

This article reviews the concerns and considerations surrounding the overuse of in vitro fertilization (IVF), as well as the underappreciation of alternatives to IVF in clinical practice and research. It summarizes the current evidence on the effectiveness, safety, and cost-effectiveness of various alternatives to IVF, such as expectant management, intrauterine insemination, tubal flushing, in vitro maturation, and intravaginal culture. The article also discusses the trend of IVF use over the last decade and the roles of different alternatives to IVF in modern reproductive medicine.