O'Brien P, Vandekerckhove P
Westside Contraceptive Services, Westminster PCT, Raymede Clinic, Exmoor St, London, UK, W10 6DZ.
Cochrane Database Syst Rev. 2007 Jul 18(4):CD000317. doi: 10.1002/14651858.CD000317.pub2.
Artificial insemination with sperm is used to improve the chances of conception for various causes of infertility. Traditionally, sperm is deposited in or around the endocervical canal (cervical insemination - CI). Some studies reported higher pregnancy rates if sperm was deposited in the uterine cavity itself (intrauterine insemination - IUI), but most were uncontrolled. However the cost and the risks (infection and anaphylaxis) of IUI may also be higher.
The objective of this review was to assess the effects of depositing donor sperm in the uterine cavity (intrauterine insemination) compared to cervical insemination.
The Cochrane Subfertility Review Group specialised register of controlled trials was searched.
Randomised trials comparing intrauterine insemination and cervical insemination, using fresh or cryopreserved semen, with or without ovarian hyperstimulation.
Trial quality assessment and data extraction were done independently by two reviewers.
Twelve studies were included. They comprised 697 patients undergoing 2215 treatment cycles. Ten trials used frozen semen, with three using ovarian hyperstimulation. Overall the methodological quality of the trials was low. The overall pregnancy rate per cycle in the intrauterine insemination group was 18% compared to 5% for cervical insemination. When cryopreserved donor sperm was used, the overall chance of pregnancy in spontaneous or clomiphene-corrected cycles was significantly higher with intrauterine insemination. This was irrespective of whether pregnancy rates were calculated on a per cycle (odds ratio 2.63, 95% confidence interval 1.85 to 3.73) or per patient (odds ratio 3.86, 95% confidence interval 1.81 to 8.25) basis. The greatest benefit appeared in trials with poor pregnancy rates (less than 6%) for cervical insemination. There was no difference in pregnancy rate between intrauterine and cervical insemination when fresh donor sperm was used (odds ratio 0.90, 95% confidence interval 0.36 to 2.24).
AUTHORS' CONCLUSIONS: Intrauterine insemination appears to be beneficial when cervical insemination using cryopreserved donor sperm has had low pregnancy rates. This applies to spontaneous, clomiphene corrected and gonadotrophin stimulated cycles. However it may offer little benefit where high pregnancy rates have been achieved with cervical insemination. There appears to be no additional benefit from intrauterine insemination when fresh sperm is used for donor insemination.
精子人工授精用于提高因各种不孕原因导致的受孕几率。传统上，精子被放置在子宫颈管内或其周围（宫颈内人工授精 - CI）。一些研究报告称，如果将精子放置在子宫腔内（宫腔内人工授精 - IUI），妊娠率会更高，但大多数研究没有对照。然而，IUI的成本和风险（感染和过敏反应）可能也更高。
本综述的目的是评估与宫颈内人工授精相比，将供体精子放置在子宫腔内（宫腔内人工授精）的效果。
检索了Cochrane不育症综述小组专门的对照试验注册库。
比较宫腔内人工授精和宫颈内人工授精的随机试验，使用新鲜或冷冻保存的精液，有或没有卵巢过度刺激。
由两位审阅者独立进行试验质量评估和数据提取。
纳入了12项研究。这些研究包括697例患者，共进行了2215个治疗周期。10项试验使用冷冻精液，其中3项使用卵巢过度刺激。总体而言，试验的方法学质量较低。宫腔内人工授精组每个周期的总体妊娠率为18%，而宫颈内人工授精组为5%。当使用冷冻保存的供体精子时，在自然周期或克罗米芬校正周期中，宫腔内人工授精的总体妊娠几率显著更高。这与妊娠率是按每个周期（优势比2.63，95%置信区间1.85至3.73）还是按每个患者（优势比3.86，95%置信区间1.81至8.25）计算无关。最大的益处出现在宫颈内人工授精妊娠率较低（低于6%）的试验中。当使用新鲜供体精子时，宫腔内人工授精和宫颈内人工授精的妊娠率没有差异（优势比0.90，95%置信区间0.36至2.24）。
当使用冷冻保存的供体精子进行宫颈内人工授精妊娠率较低时，宫腔内人工授精似乎有益。这适用于自然周期、克罗米芬校正周期和促性腺激素刺激周期。然而，在宫颈内人工授精已取得高妊娠率的情况下，它可能益处不大。当使用新鲜精子进行供体人工授精时，宫腔内人工授精似乎没有额外益处。
