This review paper summarizes information on the efficiency, major challenges and economic loss of cattle Artificial Insemination (AI) service in developing countries. Efficiency of AI service can be measured by number of services per conception (NSC), conception rate at first insemination, and calving rate (CR). The optimum recommended NSC for profitable dairy cow ranges from 1.0-2.0. The averages of NSC of the conventional AI (1.73) and fixed time AI (1.78) in the reviewed publications were in the ranges of the recommendations of NSC. The NSC varies with animal breeds, animal factor (body condition score, age and parity), semen factor (handling procedure and quality), inseminator factor (knowledge, skill and experience), production systems, management level provided and AI breeding methods. The NSC and calving rate vary with conventional AI and fixed time AI breeding methods. Likewise, calving rate (CR) is influenced by poor semen quality, poor semen handling procedure, inadequate insemination skill, poor oestrus detection and wrong time of insemination. The average success rate (CR) of conventional AI (35.15%) in the reviewed publications is far below the success rates reported in some developing countries. Nevertheless, widespread use and longtime use of AI service on selected genotype(s) can cause cattle biodiversity loss. Dairy producers incur additional costs when cows fail to conceive at their first AI services. Moreover, challenges of AI service comprised of feed scarcity, animal diseases, climate change, poor AI infrastructure, poor livestock husbandry practices, weak livestock extension systems and incapability of Artificial Insemination Technicians (AITs). This calls designing suitable interventions to improve the efficiency of AI services. Adequate feed and high level of management should be provided to the breedable cows and heifers. AI service centers should be established as per the recommended number of breedable cows and heifers. AI inputs including AITs should be always available at each AI service center, and proper AI service recording should be practiced. Sexed semen should be used to enhance the number of replacement heifers, and capacity building should be provided to AITs and community cattle breeders. Radio, television and printed medias should be used to enhance the awareness of the community cattle breeders. Frequent extension support is essential for the success rate of the AI service.