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Intrauterine Insemination (IUI)

The ESHRE Capri Workshop Group

Intrauterine insemination

The ESHRE Capri Workshop Group

  • In der Diskussion
  • Published:
Gynäkologische Endokrinologie Aims and scope

Zusammenfassung

Einleitung

Die intrauterine Insemination (IUI) mit oder ohne Stimulation der Ovarien zählt zu den allgemein gebräuchlichen Behandlungsmethoden bei vorliegender Infertilität. Trotz ihrer breiten Anwendung können keine einheitlichen Angaben zur Effektivität einer IUI-Behandlung gemacht werden.

Methoden

Eine Medline-Literaturrecherche wurde für verschiedene Themenbereiche der IUI durchgeführt: Indikation, praktische Durchführung und Effektivität für IUI nach homologer Samenspende. Die Beurteilung der Effektivität der IUI erfolgte durch Auswertung kontrollierter randomisierter Studien, Metaanalysen sowie Metaregressionsanalysen.

Ergebnisse

Für die Behandlung der männlichen Infertilität konnte, bezogen auf stimulierte IUI-Zyklen, kein signifikanter Wirkungsnachweis erbracht werden. Außerdem zeigte sich nur ein kleiner therapeutischer Effekt bezogen auf andere Diagnosen. Protokolle mit initialer Clomiphen-Citrat-Stimulation und anschließender IUI sind die am häufigsten verwendeten Protokolle mit durchschnittlicher Schwangerschaftsrate von 7% pro Zyklus. Andere Protokolle mit initialer FSH-Stimulation und anschließender IUI können die Schwangerschaftsraten nur geringfügig mit 12% SSR pro Zyklus verbessern, führen im Durchschnitt jedoch zu einer Mehrlingsrate von 13%. Obwohl eine weniger intensive ovarielle Stimulation, bei der 1–2 Follikel pro stimuliertem Zyklus heranreifen, zur Senkung der Kosten und Mehrlingsschwangerschaften führt, werden häufig jedoch mehr Therapiezyklen benötigt. Der Nachweis einer Beeinflussung der Effizienz des Verfahrens durch Kontrolle eines vorzeitigen LH-Anstiegs und Lutealphasenunterstützung ist nicht erbracht worden.

Schlussfolgerung

Die IUI benötigt eine ovarielle Stimulation, um befriedigende Ergebnisse zu erreichen. Bezogen auf die relativ hohe Mehrlingsschwangerschaftrate kann gegenüber einer IVF-Behandlung kein Vorteil der IUI-Behandlung nachgewiesen werden. Um eine abschließende Beurteilung treffen zu können, werden noch weitere aussagekräftige Studien bezüglich IUI und milder Stimulation der Ovarien und Vergleichsstudien mit anderen Protokollen benötigt.

Abstract

Background

Intrauterine insemination (IUI) with or without ovarian stimulation is a common treatment for infertility. Despite its popularity, the effectiveness of IUI treatment is not consistent, and the role of IUI and in vitro fertilization (IVF) treatment in practice protocols has not been clarified.

Methods

Medline searches were done by individual topics (utilization, procedures, effectiveness of partner but not donor IUI and related endocrine issues). Effectiveness of IUI was evaluated in relevant randomized controlled trials, using meta-analysis and meta-regression where necessary.

Results

Stimulated IUI is ineffective in male infertility and the effect on other diagnoses is small. With clomiphene citrate and IUI, the most common IUI protocol, pregnancy rates average 7% per cycle. FSH ovarian stimulation and IUI treatment is only modestly better than observation only with pregnancy rate 12% per cycle but multiple birth rates averaging 13%. Mildly stimulated (1–2 follicles) cycles might reduce the cost and multiple birth rates but may require more cycles of treatment. Prevention of premature luteinizing hormone surges and luteal phase support do not appear to be major requirements in IUI cycles.

Conclusions

IUI treatment requires ovarian stimulation to achieve modest results, but the high multiple pregnancy rates mean that it is no more than a poor substitute for IVF treatment. More trials are needed on IUI treatment with mild stimulation and on the order of IUI and other treatments.

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Literatur

  1. Abu-Heija AT, Fleming R, Yates RW, Coutts JR (1995) Pregnancy outcome following exposure to gonadotrophin-releasing hormone analogue during early pregnancy: comparisons in patients with normal or elevated luteinizing hormone. Hum Reprod 10:3317–3319

    CAS  PubMed  Google Scholar 

  2. Agarwal S, Mittal S (2004) A randomised prospective trial of intrauterine insemination versus timed intercourse in superovulated cycles with clomiphene. Indian J Med Res 120:519–522

    PubMed  Google Scholar 

  3. Albano C, Grimbizis G, Smitz J et al (1998) The luteal phase of nonsupplemental cycles afterovarian superovulation with human menopausal gonadotropin and the gonadotropin-releasing hormone antagonist Cetrorelix. Fertil Steril 70:357–359

    CAS  PubMed  Google Scholar 

  4. Allegra A, Marino A, Coffaro F et al (2007) GnRH antagonist-induced inhibition of the premature LH surge increases pregnancy rates in IUI-stimulated cycles. A prospective randomized trial. Hum Reprod 22:101–108

    CAS  PubMed  Google Scholar 

  5. Andersen AN, Gianaroli L, Felberbaum R et al (2005) Assisted reproductive technology in Europe, 2001. Results generated from European registers by ESHRE. Hum Reprod 20:1158–1176

    PubMed  Google Scholar 

  6. Andersen AN, Gianaroli L, Felberbaum R et al (2006) Assisted reproductive technology in Europe, 2002. Results generated from European registers by ESHRE. Hum Reprod 21:1680–1697

    PubMed  Google Scholar 

  7. Andersen AN, Goossens V, Gianaroli L et al (2007) Assisted reproductive technology in Europe, 2003. Results generated from European registers by ESHRE. Hum Reprod 22:1513–1525

    PubMed  Google Scholar 

  8. Andersen AN, Goossens V, Ferraretti AP et al (2008) Assisted reproductive technology in Europe, 2004: results generated from European registers by ESHRE. Hum Reprod 23:756–771

    PubMed  Google Scholar 

  9. Arici A, Byrd W, Bradshaw K, Kutteh WH et al (1994) Evaluation of clomiphene citrate and human chorionic gonadotropin treatment: a prospective, randomized, crossover study during intrauterine insemination cycles. Fertil Steril 61:314–318

    CAS  PubMed  Google Scholar 

  10. Baart EB, Martini E, Eijkemans MJ et al (2007) Milder ovarian stimulation for in-vitro fertilization reduces aneuploidy in the human preimplantation embryo: a randomized controlled trial. Hum Reprod 22:980–988

    PubMed  Google Scholar 

  11. Baird DT (2000) Mode of action of medical methods of abortion. J Am Med Womens Assoc 55 (Suppl 3):121–126

    CAS  PubMed  Google Scholar 

  12. Balasch J, Ballescá JL, Pimentel C et al (1994) Late low-dose pure follicle stimulating hormone for ovarian stimulation in intra-uterine insemination cycles. Hum Reprod 9:1863–1866

    CAS  PubMed  Google Scholar 

  13. Batista MC, Cartledge TP, Zellmer AW et al (1994) The antiprogestin RU486 delays the midcycle gonadotropin surge and ovulation in gonadotropin-releasing hormone-induced cycles. Fertil Steril 62:28–34

    CAS  PubMed  Google Scholar 

  14. Beckers NGM, Macklon NS, Eijkemans MJ et al (2003) Non supplemented luteal phase characteristics after the administration of recombinant human chorionic gonadotropin, recombinant luteinizing hormone, or gonadotropin-releasing hormone (GnRH) agonist to induce final oocyte maturation in in vitro fertilization patients after ovarian stimulation with recombinant follicle-stimulating hormone and GnRH antagonist cotreatment. J Clin Endocrinol Metab 88:4186–4192

    CAS  PubMed  Google Scholar 

  15. Bensdorp AJ, Cohlen BJ, Heineman MJ, Vandekerckhove P (2007) Intra uterine insemination for male subfertility. Cochrane Database Syst Rev 2007; Art No.: CD000360, doi: 10.1002/14651858.CD00360.pub4

  16. Besselink DH, Farquhar C, Kremer JAM et al (2008) Cervical insemination versus intra-uterine insemination of donor sperm for subfertility (Review). Cochrane Database Syst Rev 2008; Art No.: CD00317, doi: 10.1002./14651858.CD00317.pub3

  17. Bhattacharya S, Harrild K, Mollison J et al (2008) Clomifene citrate or unstimulated intrauterine insemination compared with expectant management for unexplained infertility: pragmatic randomised controlled trial. BMJ 337:716–723

    Google Scholar 

  18. Boomsma CM, Heineman MJ, Cohlen BJ, Farquhar C (2007) Semen preparation techniques for intrauterine insemination (Review). Cochrane Database Syst Rev 2007; Art No.: CD004507, doi: 10.1002/14651858,CD004507.pub3

  19. Braat DD, Schoemaker J (1991) Endocrinology of gonadotropin-releasing hormone induced cycles in hypothalamic amenorrhea: the role of the pulse dose. Fertil Steril 56:1054–1059

    CAS  PubMed  Google Scholar 

  20. Cantineau AE, Cohlen BJ. Dutch IUI Study Group (2007) The prevalence and influence of luteinizing hormone surges in stimulated cycles combined with intrauterine insemination during a prospective cohort study. Fertil Steril 88:107–112

    CAS  PubMed  Google Scholar 

  21. Cantineau AEP, Heineman MJ, Cohlen BJ (2003) Single versus double intrauterine insemination (IUI) in stimulated cycles for subfertile couples. Cochrane Database Syst Rev 2003; Art. No.: CD003854, doi: 10.1002/14651858.CD003854

  22. Cantineau AE, Cohlen BJ, Heineman MJ (2007) Ovarian stimulation protocols (anti-oestrogens, gonadotrophins with and without GnRH agonists/ antagonists) for intrauterine insemination (IUI) in women with sub fertility (Review). Cochrane Database Syst Rev 2007; Art No.: CD005356

  23. Cohen MR (1962) Intrauterine insemination. Int J Fertil 7:235–240

    CAS  PubMed  Google Scholar 

  24. Crosignani PG, Walters DE, Soliani A (1991) The ESHRE multicentre trial on the treatment of unexplained infertility: a preliminary report. Hum Reprod 6:953–958

    CAS  PubMed  Google Scholar 

  25. Crosignani PG, Somigliana E, Intrauterine Insemination Study Group (2007) Effect of GnRH antagonists in FSH mildly stimulated intrauterine insemination cycles: a multicentre randomized trial. Hum Reprod 22:500–505

    CAS  PubMed  Google Scholar 

  26. Csapo AI, Pulkkinen M (1978) Indispensability of the human corpus luteum in the maintenance of early pregnancy. Luteectomy evidence. Obstet Gynecol Surv 33:69–81

    CAS  PubMed  Google Scholar 

  27. Custers IM, Steures P, Hompes P et al (2008) Intrauterine insemination: how many cycles should we perform? Hum Reprod 23:885–888

    PubMed  Google Scholar 

  28. Dankert T, Kremer JAM, Cohlen BJ et al (2007) A randomized clinical trial of clomiphene citrate versus low dose recombinant FSH for ovarian hyperstimulation in intrauterine insemination for unexplained and male subfertility. Hum Reprod 22:792–797

    CAS  PubMed  Google Scholar 

  29. de Koning J, Lambalk CB, Helmerhorst FM, Helder MN (2001) Is GnRH self-priming an obligatory feature of the reproductive cycle? Hum Reprod 16:209–214

    Google Scholar 

  30. de Koning CH, McDonnell J, Themmen AP et al (2008) The endocrine and follicular growth dynamics throughout the menstrual cycle in women with consistently or variably elevated early follicular phase FSH compared with controls. Hum Reprod 23:1416–1423

    Google Scholar 

  31. Deaton JL, Gibson M, Blackmer KM et al (1990) A randomized, controlled trial of clomiphene citrate and intrauterine insemination in couples with unexplained infertility or surgically corrected endometriosis. Fertil Steril 54:1083–1088

    CAS  PubMed  Google Scholar 

  32. DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7:177–188

    CAS  PubMed  Google Scholar 

  33. Dickey RP, Taylor SN, Lu PY et al (2002) Effect of diagnosis, age, sperm quality, and number of preovulatory follicles on the outcome of multiple cycles of clomiphene citrate-intrauterine insemination. Fertil Steril 78:1088–1095

    PubMed  Google Scholar 

  34. Dickey RP, Taylor SN, Lu PY et al (2005) Risk factors for higher order multiple pregnancy and multiple birth after controlled ovarian hyperstimulation; results of 4,062 IUI cycles. Fertil Steril 83:671–683

    PubMed  Google Scholar 

  35. DiLuigi AJ, Nulsen JC (2007) Effects of gonadotropin-releasing hormone agonists and antagonists on luteal function. Curr Opin Obstet Gynecol 19:258–265

    PubMed  Google Scholar 

  36. Dubourdieu S, Charbonnel B, D’Acremont MF et al (1994) Effect of administration of a gonadotropin-releasing hormone (GnRH) antagonist (Nal-Glu) during the periovulatory period: the luteinizing hormone surge requires secretion of GnRH. J Clin Endocrinol Metab 78:343–347

    CAS  PubMed  Google Scholar 

  37. Ecochard R, Mathieu C, Royere D et al (2000) A randomized prospective study comparing pregnancy rates after clomiphene citrate and human menopausal gonadotropin before intrauterine insemination. Fertil Steril 73:90–93

    CAS  PubMed  Google Scholar 

  38. ESHRE Capri Workshop Group (2004) Diagnosis and management of the infertile couple: missing information. Hum Reprod Update 10:295–307

    Google Scholar 

  39. ESHRE Capri Workshop Group (2007) Intracytoplasmic sperm injection (ICSI) in 2006: evidence and evolution. Hum Reprod Update 13:515–526

    Google Scholar 

  40. Fauser BCJM, Devroey P, Macklon NS (2005) Multiple birth resulting from ovarian stimulation for subfertility treatment. Lancet 365:1807–1816

    PubMed  Google Scholar 

  41. Fazleabas AT (2007) Physiology and pathology of implantation in the human and nonhuman primate. Semin Reprod Med 25:405–409

    PubMed  Google Scholar 

  42. Ghesquiere SL, Castelain EG, Spiessens C et al (2007) Relationship between follicle number and (multiple) live birth rate after controlled ovarian hyperstimulation and intrauterine insemination. Am J Obstet Gynecol 197:589.e1–5

    PubMed  Google Scholar 

  43. Gleicher N, Oleske DM, Tur-Kaspa I et al (2000) Reducing the risk of higher order multiple pregnancy after ovarian stimulation with gonadotropins. N Engl J Med 343:2–7

    CAS  PubMed  Google Scholar 

  44. Gomez-Polomares JL, Juliia B, Acevedo-Martin B et al (2005) Timing ovulation for intrauterine insemination with a GnRH antagonist. Hum Reprod 20:368–372

    Google Scholar 

  45. Gómez-Palomares JL, Acevedo-Martín B, Chávez M et al (2008) Multifollicular recruitment in combination with gonadotropin-releasing hormone antagonist increased pregnancy rates in intrauterine insemination cycles. Fertil Steril 89:620–624

    PubMed  Google Scholar 

  46. Goverde AJ, McDonnell J, Vermeiden JP et al (2000) Intrauterine insemination or in-vitro fertilisation in idiopathic subfertility and male subfertility: a randomised trial and cost-effectiveness analysis. Lancet 355:13–18

    CAS  PubMed  Google Scholar 

  47. Goverde AJ, Lambalk CB, McDonnell J et al (2005) Further consideration on natural or mild hyperstimulation cycles for intrauterine insemination treatment: effects on pregnancy and multiple pregnancy rates. Hum Reprod 20:3141–3146

    CAS  PubMed  Google Scholar 

  48. Gregoriou O, Vitoratos N, Papadias C et al (1995) Controlled ovarian hyperstimulation with or without intrauterine insemination for the treatment of unexplained infertility. Int J Gynaecol Obstet 48:55–59

    CAS  PubMed  Google Scholar 

  49. Gulumser C, Narvekar N, Conway G et al (2008) Limiting multiple pregnancies in 4242 cycles of IUI: increase in follicle numbers increases multiple pregnancy but not clinical pregnancy rate!. Hum Reprod 23(Suppl 1):i63

    Google Scholar 

  50. Guzick DS, Carson SA, Coutifaris C et al (1999) Efficacy of superovulation and intrauterine insemination in the treatment of infertility. N Engl J Med 340:177–183

    CAS  PubMed  Google Scholar 

  51. Haagen EC, Hermens RP, Nelen WL et al (2006) Subfertility guidelines in Europe: the quantity and quality of intrauterine insemination guidelines. Hum Reprod 21:2103–2109

    CAS  PubMed  Google Scholar 

  52. Haagen EC, Hermens RP, Nelen WL et al (2008) Subfertile couples‘ negative experiences with intrauterine insemination care. Fertil Steril 89:809–816

    PubMed  Google Scholar 

  53. Heijnen EM, Eijkemans MJ, De Klerk C et al (2007) A mild treatment strategy for in-vitro fertilisation: a randomised non-inferiority trial. Lancet 369:743–749

    PubMed  Google Scholar 

  54. Hughes EG, Beecroft ML, Wilkie V et al (2004) A multicentre randomized controlled trial of expectant management versus IVF in women with Fallopian tube patency. Hum Reprod 19:1105–1109

    CAS  PubMed  Google Scholar 

  55. Ibérico G, Vioque J, Ariza N et al (2004) Analysis of factors influencing pregnancy rates in homologous intrauterine insemination. Fertil Steril 81:1308–1313

    PubMed  Google Scholar 

  56. Kahn JA, Von During V, Sunde A et al (1992) Fallopian tube sperm perfusion: first clinical experience. Hum Reprod 7(Suppl 1):19–24

    PubMed  Google Scholar 

  57. Kahn JA, von Düring V, Sunde A, Molne K (1992) Fallopian tube sperm perfusion used in a donor insemination programme. Hum Reprod 7:806–812

    CAS  PubMed  Google Scholar 

  58. Kahn JA, Sunde A, Koskemies A et al (1993) Fallopian tube sperm perfusion (FSP) versus intrauterine insemination (IUI) in the treatment of unexplained infertility: a prospective randomized study. Hum Reprod 8:890–894

    CAS  PubMed  Google Scholar 

  59. Kamel MA (1995) Effect of induction protocols on pregnancy rate in artificial insemination by husband (Abstract book). Hum Reprod 10:116

    Google Scholar 

  60. Karande VC, Korn A, Morris R et al (1999) Prospective randomized trial comparing the outcome and cost of in vitro fertilization with that of a traditional treatment algorithm as first-line therapy for couples with infertility. Fertil Steril 71:468–475

    CAS  PubMed  Google Scholar 

  61. Karlstrom PO, Bergh T, Lundkvist O (1993) A prospective randomized trial of artificial insemination versus intercourse in cycles stimulated with human menopausal gonadotropin or clomiphene citrate. Fertil Steril 59:554–559

    CAS  PubMed  Google Scholar 

  62. Karlstrom PO, Berkurezion M, Bergh T, Lundkvist O (1998) An extended prospective randomized trial of artificial insemination versus intercourse in cycles stimulated with human menopausal gonadotrophins (hMG) or clomiphene citrate (CC). Fertil Steril 70 (Suppl 1):S420

    Google Scholar 

  63. Kerin JF, Peek J, Warnes GM et al (1984) Improved conception rate after intrauterine insemination of washed spermatozoa from men with poor quality semen. Lancet 1:533–535

    CAS  PubMed  Google Scholar 

  64. Keulers MJ, Hamilton CJ, Franx A et al (2007) The length of the fertile window is associated with the chance of spontaneously conceiving an ongoing pregnancy in subfertile couples. Hum Reprod 22:1652–1656

    CAS  PubMed  Google Scholar 

  65. Khalil MR, Rasmussen PE, Erb K et al (2001) Intrauterine insemination with donor semen. An evaluation of prognostic factors based on a review of 1131 cycles. Acta Obstet Gynecol Scand 80:342–348

    CAS  PubMed  Google Scholar 

  66. Khalil MR, Rasmussen PE, Erb K et al (2001) Homologous intrauterine insemination. An evaluation of prognostic factors based on a review of 2473 cycles. Acta Obstet Gynecol Scand 80:74–81

    CAS  PubMed  Google Scholar 

  67. Klein NA, Harper AJ, Houmard BS et al (2002) Is the short follicular phase in older women secondary to advanced or accelerated dominant follicle development? J Clin Endocrinol Metab 87:5746–5750

    CAS  PubMed  Google Scholar 

  68. Knobil E (1992) Discovery of the hypothalamic gonadotropin-releasing hormone pulse generator and of its physiologic significance. Endocrinology 131:1005–1006

    CAS  PubMed  Google Scholar 

  69. Kolibianakis EM, Bourgain C, Platteau P et al (2003) Abnormal endometrial development occurs during the luteal phase of nonsupplemental donor cycles treated with recombinant follicle-stimulating hormone and gonadotropin-releasing hormone antagonists. Fertil Steril 80:464–466

    PubMed  Google Scholar 

  70. Lambalk CB, Leader A, Olivennes F et al (2006) Treatment with the GnRH antagonist ganirelix prevents premature LH rises and luteinization in stimulated intrauterine insemination: results of a double-blind, placebo-controlled, multicentre trial. Hum Reprod 21:632–639

    CAS  PubMed  Google Scholar 

  71. Lee TH, Lin YH, Seow KM et al (2008) Effectiveness of cetrorelix for the prevention of premature luteinizing hormone surge during controlled ovarian stimulation using letrozole and gonadotropins: a randomized trial. Fertil Steril 90:113–120

    CAS  PubMed  Google Scholar 

  72. Liu J, Nagy Z, Joris H et al (1995) Analysis of 76 total fertilization failure cycles out of 2732 intracytoplasmic sperm injection cycles. Hum Reprod 10:2630–2636

    CAS  PubMed  Google Scholar 

  73. Lunenfeld B (2004) Historical perspectives in gonadotrophin therapy. Hum Reprod Update 10:453–467

    CAS  PubMed  Google Scholar 

  74. Macklon NS, Fauser BC (2000) Impact of ovarian hyperstimulation on the luteal phase. J Reprod Fertil 55 (Suppl l):101–108

    CAS  Google Scholar 

  75. Mardon H, Grewal S, Mills K (2007) Experimental models for investigating implantation of the human embryo. Semin Reprod Med 25:410–417

    PubMed  Google Scholar 

  76. Martinez AR, Bernardus RE, Voorhorst FJ et al (1990) Intrauterine insemination does and clomiphene citrate does not improve fecundity in couples with infertility due to male or idiopathic factors: a prospective, randomized, controlled study. Fertil Steril 53:847–853

    CAS  PubMed  Google Scholar 

  77. Mastenbroek S, Twisk M, van Echten-Arends J et al (2007) In vitro fertilization with preimplantation genetic screening. N Engl J Med 357:9–17

    CAS  PubMed  Google Scholar 

  78. Matorras R, Diaz T, Corcostegui B et al (2002) Ovarian stimulation in intrauterine insemination with donor sperm: a randomized study comparing clomiphene citrate in fixed protocol versus highly purified urinary FSH. Hum Reprod 17:2107–2111

    CAS  PubMed  Google Scholar 

  79. Moomjy M, Sills ES, Rosenwaks Z, Palermo GD (1998) Implications of complete fertilization failure after intracytoplasmic sperm injection for subsequent fertilization and reproductive outcome. Hum Reprod 13:2212–2216

    CAS  PubMed  Google Scholar 

  80. Murdoch AP, Harris M, Mahroo M et al (1991) Gamete intrafallopian transfer (GIFT) compared with intrauterine insemination in the treatment of unexplained infertility. Br J Obstet Gynaecol 98:1107–1111

    CAS  PubMed  Google Scholar 

  81. Nan PM, Cohlen BJ, te Velde ER et al (1994) Intra-uterine insemination or timed intercourse after ovarian stimulation for male subfertility? A controlled study. Hum Reprod 9:2022–2026

    CAS  PubMed  Google Scholar 

  82. National Institute for Clinical Excellence (2004) http://www.nice.org.uk/ nicemedia/pdf/CG011

  83. Nulsen J, Wheeler C, Ausmanas M, Blasco L (1987) Cervical mucus changes in relationship to urinary luteinizing hormone. Fertil Steril 48:783–786

    CAS  PubMed  Google Scholar 

  84. Ombelet W (2005) IUI and evidence-based medicine: an urgent need for translation into our clinical practice. Gynecol Obstet Invest 59:1–2

    PubMed  Google Scholar 

  85. Pashayan N, Lyratzopoulos G, Mathur R (2006) Cost-effectiveness of primary offer of IVF vs. primary offer of IUI followed by IVF (for IUI failures) in couples with unexplained or mild male factor subfertility. BMC Health Serv Res 6:80

    PubMed  Google Scholar 

  86. Ragni G, Vegetti W, Baroni E et al (2001) Comparison of luteal phase profile in gonadotrophin stimulated cycles with or without a gonadotrophin-releasing hormone antagonist. Hum Reprod 2001;16:2258–2262

    Google Scholar 

  87. Ragni G, Somigliana E, Vegetti W (2004) Timing of intrauterine insemination: where are we? Fertil Steril 82:25–26

    PubMed  Google Scholar 

  88. Ragni G, Allegra A, Anserini P et al (2005) The 2004 Italian legislation regulating assisted reproduction technology: a multicentre survey on the results of IVF cycles. Hum Reprod 20:2224–2228

    CAS  PubMed  Google Scholar 

  89. Ragni G, Caliari I, Nicolosi AE et al (2006) Preventing higher order multiple pregnancies during controlled ovarian hyperstimulation and intrauterine insemination: 3 years‘ experience using low dose recombinant follicle-stimulating hormone and gonadotropinreleasing hormone antagonist. Fertil Steril 2006;85:619–624

    Google Scholar 

  90. Reindollar RH, Regan MM, Neumann PJ et al. (2007) A randomized controlled trial of 503 couples assigned to conventional infertility treatment or an accelerated track to IVF: preliminary results of the fast track and standard treatment (FASTT) trial. Fertil Steril 86:S841

    Google Scholar 

  91. Snick HK, Collins JA, Evers JLH (2008) What is the most valid comparison treatment in trials of intrauterine insemination, timed or uninfluenced intercourse? A systematic review and meta-analysis of indirect evidence. Hum Reprod 23:2239–2245

    CAS  PubMed  Google Scholar 

  92. Soliman S, Daya S, Collins J, Jarrell J (1993) A randomized trial of in vitro fertilization versus conventional treatment for infertility. Fertil Steril 59:1239–1244

    CAS  PubMed  Google Scholar 

  93. Steures P, van der Steeg JW, Mol BWJ et al (2004) Prediction of an ongoing pregnancy after intrauterine insemination. Fertil Steril 82:45–51

    PubMed  Google Scholar 

  94. Steures P, van der Steeg JW, Hompes PG et al (2006) Intrauterine insemination with controlled ovarian hyperstimulation versus expectant management for couples with unexplained subfertility and an intermediate prognosis: a randomised clinical trial. Lancet 368:216–221

    PubMed  Google Scholar 

  95. Steures P, van der Steeg JW, Hompes PG et al (2007) Effectiveness of intrauterine insemination in subfertile couples with an isolated cervical factor: a randomized clinical trial. Fertil Steril 88:1692–1696

    PubMed  Google Scholar 

  96. Strandell A, Bergh C, Söderlund B et al (2003) Fallopian tube sperm perfusion: the impact of sperm count and morphology on pregnancy rates. Acta Obstet Gynecol Scand 82:1023–1029

    PubMed  Google Scholar 

  97. Swain JE, Pool TB (2008) ART failure: oocyte contributions to unsuccessful fertilization. Hum Reprod Update 14:431–446

    PubMed  Google Scholar 

  98. Tanahatoe SJ, McDonnell J, Goverde AJ et al (2009) Total fertilization failure and idiopathic subfertility. Reprod Biol Endocrinol 7:3

    PubMed  Google Scholar 

  99. Tapia A, Gangi LM, Zegers-Hochschild F et al (2008) Differences in the endometrial transcript profile during the receptive period between women who were refractory to implantation and those who achieved pregnancy. Hum Reprod 23:340–351

    CAS  PubMed  Google Scholar 

  100. Tarlatzis BC, Fauser BC, Kolibianakis EM et al (2006) GnRH antagonists in ovarian stimulation for IVF. Hum Reprod Update 12:333–340

    CAS  PubMed  Google Scholar 

  101. The Practice Committee of the American Society for Reproductive Medicine (2006) Optimal evaluation of the infertile female. Fertil Steril 86 (Suppl 4):S264–S267

    Google Scholar 

  102. Tur R, Barri PN, Coroleu B, Buxaderas R et al (2001) Risk factors for high-order multiple implantation after ovarian stimulation with gonadotrophins: evidence from a large series of 1878 consecutive pregnancies in a single centre. Hum Reprod 16:2124–2129

    CAS  PubMed  Google Scholar 

  103. Tur R, Barri PN, Coroleu B et al (2005) Use of a prediction model for high-order multiple implantation after ovarian stimulation with gonadotropins. Fertil Steril 83:116–121

    CAS  PubMed  Google Scholar 

  104. van Rumste MME, den Hartog JE, Dumoulin JCM et al (2006) Is controlled ovarian stimulation in intrauterine insemination an acceptable therapy in couples with unexplained non-conception in the perspective of multiple pregnancies? Hum Reprod 21:701–704

    Google Scholar 

  105. van Rumste MME, Custers IM, van der Veen F et al (2008) The influence of the number of follicles on pregnancy rates in intrauterine insemination with ovarian hyperstimulation: a meta-analysis. Hum Reprod Update 14:563–570

    Google Scholar 

  106. Van Voorhis BJ, Stovall DW, Allen BD, Syrop CH (1998) Cost-effective treatment of the infertile couple. Fertil Steril 70:995–1005

    Google Scholar 

  107. Van Voorhis BJ, Barnett MR, Sparks AE et al (2001) Effect of the total motile sperm count on the efficacy and cost-effectiveness of intrauterine insemination and in vitro fertilization. Fertil Steril 75:661–668

    Google Scholar 

  108. van Weert JM, van den Broek J, van der Steeg JW et al (2007) Patients‘ preferences for intrauterine insemination or in-vitro fertilization. Reprod Biomed Online 15:422–427

    Article  Google Scholar 

  109. Verhulst SM, Cohlen BJ, Hughes E et al (2006) Intra-uterine insemination for unexplained subfertility. Cochrane Database Syst Rev 2006; Art No.: CD001838

  110. Wilcox AJ, Weinberg CR, Baird DB (1995) Timing of intercourse in relation to ovulation: effects on the probability of conception, survival of the pregnancy and sex of the baby. N Engl J Med 333:1517–1521

    CAS  PubMed  Google Scholar 

  111. Wilcox AJ, Baird DD, Dunson DB et al (2004) On the frequency of intercourse around ovulation: evidence for biological influences. Hum Reprod 19:1539–1543

    CAS  PubMed  Google Scholar 

  112. Zegers-Hochschild F, Nygren KG, Adamson GD et al (2006) The ICMART glossary on ART terminology. Hum Reprod 21:1968–1970

    PubMed  Google Scholar 

  113. Zegers-Hochschild F, Nygren KG, Adamson GD et al (2006) The International Committee Monitoring Assisted Reproductive Technologies (ICMART) glossary on ART terminology. Fertil Steril 86:16–19

    PubMed  Google Scholar 

  114. Zikopoulos K, West CP, Thong PW et al (1993) Homologous intra-uterine insemination has no advantage over timed natural intercourse when used in combination with ovulation induction for the treatment of unexplained infertility. Hum Reprod 8:563–567

    CAS  PubMed  Google Scholar 

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  1. Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Schleswig Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschlands

    D.A. Beyer

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The ESHRE Capri Workshop Group in Human Reproduction Update (2009) Vol. 15, No. 3, pp 265–277; mit freundlicher Genehmigung von Oxford University Press, European Society of Human Reproduction and Embryology sowie Prof. Dr. Piergiorgio Crosignani, Mailand/Italien; Übersetzung: Dr. Daniel A. Beyer, Lübeck.

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Beyer, D. Intrauterine Insemination (IUI). Gynäkologische Endokrinologie 7, 263–273 (2009). https://doi.org/10.1007/s10304-009-0320-y

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