Background: Intrauterine insemination (IUI) is a widely used first-line assisted reproductive technology (ART) in which pharmacologic interventions largely determine efficacy and safety. Therefore, this study aimed to synthesize and critically evaluate evidence on pharmacologic strategies utilized in IUI, focusing on clinical outcomes, safety profiles, and unresolved clinical controversies. Methods: A narrative review was conducted using PubMed, Scopus, and Web of Science to identify English-language studies (2000–2025) addressing the pharmacologic management of IUI cycles. Randomized controlled trials, systematic reviews, meta-analyses, and major clinical guidelines were prioritized in this review. Results: Based on the findings, ovarian stimulation agents, such as clomiphene citrate, aromatase inhibitors, and gonadotropins, demonstrated differing efficacy–risk profiles. Notably, it was revealed that mild stimulation protocols provide the most favorable balance between pregnancy rates and complications. Nonetheless, evidence supporting emerging technologies (e.g., artificial intelligence-guided protocols and biomarker-driven dosing) remains preliminary. Conclusion: Overall, pharmacologic management is central to IUI success. Individualized, evidence-based stimulation strategies emphasizing safety over maximal follicular recruitment should guide clinical practice.
Mohammadian et al. (Mon,) studied this question.
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