Intrauterine Insemination

Introduction . Intrauterine insemination (IUI) is an assisted conception technique that involves the deposition of a treated sperm sample into the upper part of the uterine cavity, overcoming the natural barriers to the ascent of sperm into the female reproductive tract. The rationale for the use of artificial insemination is to increase the density of male gametes at the fertilization site.

Indications . It is a non-invasive and cost-effective first-line therapy for selected patients with patent and functioning tubes, cervical factor infertility, anovulation, moderate male factor, infertility, immunological factor and ejaculatory disorders. Possibility of pregnancy: Unfortunately, the pregnancy rate per treatment cycle does not exceed 10-15%.

Limitations of the technique. It has limited use in patients with endometriosis, severe male factor infertility, tubal factor infertility, and advanced maternal age ≥ 35 years. IUI can be performed with or without ovarian stimulation.

How it is performed. Controlled ovarian stimulation, especially with low-dose gonadotropins, with IUI offers a significant benefit in terms of pregnancy outcomes compared to natural cycle or timed intercourse, while reducing complications associated with ovarian hyperstimulation, such as multiple pregnancies and ovarian hyperstimulation syndrome.

Prognosis . Important prognostic indicators of success with IUI include patient age, duration of infertility, stimulation protocol, etiology of infertility, number of treatment cycles, timing of insemination, number of preovulatory follicles on the day of hCG, total number of motile sperm processed > 10 million, and sperm count greater than 5 million with more than 4% morphologically normal sperm.

Conclusions . Intrauterine insemination with ovulation induction can be an effective first-line treatment in many cases: it is simple and is preferred by many clinicians because it is less invasive than in vitro fertilization. A complete couple workup including history, physical examination, clinical and laboratory investigations is mandatory to justify the choice in favor of IUI and guide the alternative management of the patient, while individualization of the treatment protocol according to the characteristics of the patient, with a strict policy of cancellation of the treatment cycle itself to limit multifollicular development, can help optimize pregnancy outcomes with IUI.