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 factors, 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 (COH), 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 administration, processed total motile sperm >ten 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 cancellation policy to limit multifollicular development may help optimize IUI pregnancy outcomes.
摘要译文
宫腔内人工授精（IUI）是一种辅助生殖技术，涉及在子宫腔内沉积处理过的精液样本，从而克服了女性生殖道中精子上升的天然障碍。对于某些因宫颈因素，无排卵，中度男性因素，无法解释的因素，免疫因素和射精障碍而导致功能正常的输卵管和不育的特定患者，这是一种经济有效的无创一线治疗，每个周期的临床妊娠率范围为10％到20％。但是，它在子宫内膜异位症，严重男性不育症，输卵管因素不育症和孕妇年龄≥35岁的患者中使用有限。可以在有或没有卵巢刺激的情况下进行IUI。与自然周期或定时性行为相比，IUI的控制性卵巢刺激（COH），特别是低剂量促性腺激素，在妊娠结局方面具有显着优势，同时减少了相关的COH并发症，如多胎妊娠和卵巢过度刺激综合征（OHSS）。 IUI成功的重要预后指标包括患者的年龄，不孕持续时间，刺激方案，不孕病因，周期数，授精时间，hCG给药当天排卵前卵泡的数量，活动精子总数> 1000万和受精计数> 1×10 6 ，正常精子> 4％。与IUI相比，其他输精技术，如输卵管精子灌注，颈内人工授精和输卵管内人工授精，没有其他好处。必须进行完整的夫妇检查，包括患者病史，体格检查以及临床和实验室检查，以证明选择IUI的合理性并指导替代患者管理，同时根据患者特征个性化治疗方案并采用严格的取消政策以限制多囊发育可能有助于优化IUI妊娠结局。
Gautam N. Allahbadia.1;Rubina Merchant.2;Akanksha Allahbadia.2;Goral Gandhi.1;Swati Allahbadia.2. Intrauterine Insemination. In Vitro Fertilization[M].DE: Springer, 2019: 361-382