摘要
Intrauterine insemination (IUI) is an assisted reproductive technique that involves the deposition of a processed semen sample in the uterine cavity, overcoming natural barriers to sperm ascent in the female reproductive tract. It is a cost-effective, noninvasive first-line therapy for selected patients with functionally normal tubes, and infertility due to a cervical factor, anovulation, moderate male factor, unexplained factors, immunological factor, and ejaculatory disorders with clinical pregnancy rates per cycle ranging from 10% to 20%. It, however, has limited use in patients with endometriosis, severe male factor infertility, tubal factor infertility, and advanced maternal age ≥35 years. IUI may be performed with or without ovarian stimulation. Controlled ovarian stimulation, particularly with low-dose gonadotropins, with IUI offers significant benefit in terms of pregnancy outcomes compared with natural cycle or timed intercourse, while reducing associated COH complications such as multiple pregnancies and ovarian hyperstimulation syndrome (OHSS). Important prognostic indicators of success with IUI include patient’s age, duration of infertility, stimulation protocol, infertility etiology, number of cycles, timing of insemination, number of preovulatory follicles on the day of hCG, processed total motile sperm >10 million, and insemination count >1 × 106 with >4% normal spermatozoa. Alternative insemination techniques, such as Fallopian tube sperm perfusion, intracervical insemination, and intratubal insemination, provide no additional benefit compared to IUI. A complete couple workup that includes patient history, physical examination, and clinical and laboratory investigations is mandatory to justify the choice in favor of IUI and guide alternative patient management, while individualizing the treatment protocol according to the patient characteristics with a strict cancelation policy to limit multifollicular development may help optimize IUI pregnancy outcomes.
摘要译文
宫腔内人工授精（IUI）是涉及在子宫腔内的处理精液样本的沉积，克服天然屏障精子上升在女性生殖道的辅助生殖技术。这是一个具有成本效益的，非侵入性的一线治疗选择的患者有正常的功能管和不孕因宫颈因素，不排卵，中度男性因素，不明原因的因素，免疫因素，射精障碍临床怀孕率每个周期不等从10％的25至20％的25。然而，它在子宫内膜异位症，严重的男性因素不孕，输卵管性不孕，以及先进的产妇年龄≥35年有限使用。宫腔内人工授精可能具有或不具有卵巢刺激下进行。控制卵巢刺激，尤其是低剂量的促性腺素，宫腔内人工授精与提供与自然周期或定时性交相比，怀孕结果方面显著的好处，同时减少相关并发症COH如多胎妊娠及卵巢过度刺激综合征（OHSS）。与宫腔内人工授精成功的重要的预后指标，包括患者的年龄，不孕不育，刺激方案，不孕不育的病因，循环次数，人工授精的时机，对hCG的一天排卵前卵泡的数量持续时间，处理的总活动精子大于10万，而人工授精数大于1×106 \u003c/ SUP\u003e与＆GT; 4％25正常精子。替代授精技术，如输卵管精子灌注，宫颈内授精和intratubal授精，提供没有额外的好处相比IUI。一个完整的夫妇的后处理，包括患者的病史，体格检查，临床和实验室检查是强制性的理由选择有利于IUI，引导替代患者管理，同时根据与严格的政策，取消限制病人的特点的个体化治疗方案multifollicular发展可能有助于优化IUI妊娠结局。
Gautam N. Allahbadia MD, DNB, FNAMS (1); Rubina Merchant PhD (1);. Intrauterine Insemination. Practical Manual of In Vitro Fertilization Advanced Methods and Novel Devices[M].DE: Springer, 2012: 281-296