Starosta Anabel, Gordon Catherine E, Hornstein Mark D
Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Massachusetts, Boston, USA.
Fertil Res Pract. 2020 Dec 11;6(1):23. doi: 10.1186/s40738-020-00092-1.
Intrauterine insemination (IUI) is a frequently utilized method of assisted reproduction for patients with mild male factor infertility, anovulation, endometriosis, and unexplained infertility. The purpose of this review is to discuss factors that affect IUI outcomes, including infertility diagnosis, semen parameters, and stimulation regimens.
We reviewed the published literature to evaluate how patient and cycle specific factors affect IUI outcomes, specifically clinical pregnancy rate, live birth rate, spontaneous abortion rate and multiple pregnancy rate.
Most data support IUI for men with a total motile count > 5 million and post-wash sperm count > 1 million. High sperm DNA fragmentation does not consistently affect pregnancy rates in IUI cycles. Advancing maternal and paternal age negatively impact pregnancy rates. Paternal obesity contributes to infertility while elevated maternal BMI increases medication requirements without impacting pregnancy outcomes. For ovulation induction, letrozole and clomiphene citrate result in similar pregnancy outcomes and are recommended over gonadotropins given increased risk for multiple pregnancies with gonadotropins. Letrozole is preferred for obese women with polycystic ovary syndrome. IUI is most effective for women with ovulatory dysfunction and unexplained infertility, and least effective for women with tubal factor and stage III-IV endometriosis. Outcomes are similar when IUI is performed with ovulation trigger or spontaneous ovulatory surge, and ovulation may be monitored by urine or serum. Most pregnancies occur within the first four IUI cycles, after which in vitro fertilization should be considered.
Providers recommending IUI for treatment of infertility should take into account all of these factors when evaluating patients and making treatment recommendations.
宫腔内人工授精（IUI）是一种常用于治疗轻度男性因素不育、无排卵、子宫内膜异位症和不明原因不育患者的辅助生殖方法。本综述的目的是讨论影响IUI结局的因素，包括不育诊断、精液参数和刺激方案。
我们回顾了已发表的文献，以评估患者和周期特异性因素如何影响IUI结局，特别是临床妊娠率、活产率、自然流产率和多胎妊娠率。
大多数数据支持对总活动精子数>500万且洗涤后精子数>100万的男性进行IUI。高精子DNA碎片率并不一致地影响IUI周期的妊娠率。父母年龄的增加对妊娠率有负面影响。父亲肥胖会导致不育，而母亲BMI升高会增加药物需求，但不影响妊娠结局。对于促排卵，来曲唑和枸橼酸氯米芬导致相似的妊娠结局，鉴于使用促性腺激素会增加多胎妊娠的风险，因此推荐使用来曲唑和枸橼酸氯米芬而不是促性腺激素。来曲唑是多囊卵巢综合征肥胖女性的首选。IUI对排卵功能障碍和不明原因不育的女性最有效，对输卵管因素和III-IV期子宫内膜异位症的女性最无效。使用排卵触发剂或自然排卵高峰进行IUI时结局相似，排卵可通过尿液或血清监测。大多数妊娠发生在前四个IUI周期内，此后应考虑体外受精。
为不育症患者推荐IUI治疗的医生在评估患者和提出治疗建议时应考虑所有这些因素。
