Massin N, Cédrin-Durnerin I, Hugues J-N
Service de médecine de la reproduction, hôpital Jean Verdier, université Paris-XIII, avenue du 14-Juillet, 93143 Bondy, France.
Gynecol Obstet Fertil. 2004 Oct;32(10):898-903. doi: 10.1016/j.gyobfe.2004.07.015.
Intrauterine insemination (i.u.i.) is usually proposed as the first-line therapy for infertility related to cervical factor, male and unexplained infertility. The overall success rate of i.u.i. is about 10-20% clinical pregnancies per cycle. i.u.i. may be performed in patients with or without prior controlled ovarian hyperstimulation (COH). The aim of COH is to closely monitor follicular growth in order to achieve a timely triggering of ovulation and i.u.i. Additionally, ovarian stimulation allows to increase the number of developing follicles. According to the review of previous prospective randomized studies and meta-analyses, it seems that: (i) when a cervical factor is involved, the advantage of COH in conjunction with i.u.i. is likely but has to be confirmed; (ii) in male infertility, COH with gonadotropins in conjunction with i.u.i. increases the clinical pregnancy rate by two. In this situation, the better the sperm parameters are, the more advantageous COH is; (iii) in unexplained infertility, COH in addition to i.u.i. improves the pregnancy rate but stimulation with clomifene citrate appears to be less effective than gonadotropins administration. Beside the sperm parameters, the success rate depends on both woman's age and degree of ovarian stimulation. Meanwhile, ovarian hyperstimulation exposes to the risk of multiple pregnancy and hyperstimulation syndrome. Increasing the number of preovulatory follicles from one to two allows to approximately double the pregnancy rate. However, there is clear evidence that getting three or more than three follicles exposes to a worrying risk of multiple pregnancy. At the present time, the successful outcome of i.u.i. should not be assessed by the clinical pregnancy rate any longer but by the singleton birth rate. Our therapeutic strategy for COH prior to i.u.i. should take into account woman's age, infertility duration and associated infertility factors. The objective in terms of preovulatory follicle number must be determined prior to the stimulation in order to optimise the cycle outcome with a singleton birth.
宫腔内人工授精（IUI）通常被推荐为治疗与宫颈因素、男性因素及不明原因不孕相关的不孕症的一线疗法。IUI的总体成功率约为每个周期10%-20%的临床妊娠率。IUI可在有或没有预先控制性卵巢过度刺激（COH）的患者中进行。COH的目的是密切监测卵泡生长，以便及时触发排卵和进行IUI。此外，卵巢刺激可增加发育中卵泡的数量。根据以往前瞻性随机研究和荟萃分析的综述，似乎：（i）当涉及宫颈因素时，COH联合IUI可能有优势，但有待证实；（ii）在男性不育症中，使用促性腺激素的COH联合IUI可使临床妊娠率提高两倍。在这种情况下，精子参数越好，COH越具优势；（iii）在不明原因不孕中，IUI之外的COH可提高妊娠率，但枸橼酸氯米芬刺激似乎不如促性腺激素给药有效。除精子参数外，成功率还取决于女性年龄和卵巢刺激程度。同时，卵巢过度刺激存在多胎妊娠和过度刺激综合征的风险。将排卵前卵泡数量从一个增加到两个可使妊娠率大约翻倍。然而，有明确证据表明，有三个或更多卵泡会面临令人担忧的多胎妊娠风险。目前，IUI的成功结果不应再通过临床妊娠率来评估，而应通过单胎出生率来评估。我们在IUI前进行COH 的治疗策略应考虑女性年龄、不孕持续时间和相关不孕因素。为了以单胎出生优化周期结果，必须在刺激前确定排卵前卵泡数量的目标。
