Advertisement

Inseminationsbehandlung

  • Christoph DornEmail author
Chapter
Part of the Springer Reference Medizin book series (SRM)

Zusammenfassung

Das Ziel der Insemination ist, gut aufbereitete Spermien zum optimalen Zeitpunkt intrauterin zu befördern. Die Indikationen sind der zervikale und andrologische Faktor sowie die idiopathische Sterilität. Auch Endometriose Grad 1 (–2), Impotentia coeundi und Vaginismus stellen Indikationen zur Insemination dar. Weitere Möglichkeiten bestehen bei lesbischen Paaren, Infektiosität bei serodiskordanten Paaren (HIV oder Hepatitis) und die donogene Insemination. Der wichtigste Parameter scheint die Anzahl der beweglichen Spermien nach Aufarbeitung zu sein und sollte als Minimum 5 Mio. betragen. Eine maximale Karenzzeit der Ejakulation vor Insemination von 2–4 Tagen wird empfohlen. Aufgrund der Kostensituation ist eine Clomifenstimulation zur Insemination primär der Vorzug zu geben. Der Inseminationszeitpunkt sollte ca. 32–36 h nach HCG-Gabe oder 24 h nach endogenem LH-Anstieg erfolgen.

Literatur

  1. Aboulghar M, Mansour R, Serour G, Abdrazek A, Amin Y, Rhodes C (2000) Controlled ovarian hyperstimulation and intrauterine insemination for treatment of unexplained infertility should be limited to a maximum of three trials. Fertil Steril 75:88–91CrossRefGoogle Scholar
  2. Aboulghar MA, Mourad LM, Al-Inany HG, Aboulghar MM, Mansour RT, Serour GA (2010) Prospective randomized study for hydrotubation versus no hydrotubation before intrauterine insemination in unexplained infertility. Reprod Biomed Online 20(4):543–546PubMedCrossRefGoogle Scholar
  3. Abu Hashim H, Ombar O, Abd Elaal I (2011) Intrauterine insemination versus timed intercourse with clomiphene citrate in polycystic ovary syndrome: a randomized controlled trial. Acta Obstet Gynecol Scand 90(4):344–350PubMedCrossRefGoogle Scholar
  4. Akanji TH, Bhattacharya S (2010) The role of intrauterine insemination in male infertility. Hum Fertil (Camb) 13:226–232CrossRefGoogle Scholar
  5. Arab-Zozani M, Nastri CO (2017) Single versus double intrauterine insemination (IUI) for pregnancy: a systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 215:75–84PubMedCrossRefGoogle Scholar
  6. Bakas P, Konidaris S, Liapis A, Gregoriou O, Tzanakaki D, Creatsas G (2011) Role of gonadotropin-releasing hormone antagonist in the management of subfertile couples with intrauterine insemination and controlled ovarian stimulation. Fertil Steril 95(6):2024–2028PubMedCrossRefGoogle Scholar
  7. Beckers NG, Macklon NS, Eijkemans MJ, Ludwig M, Felberbaum RE, Diedrich K, Bustion S, Loumaye E, Fauser BC (2003) Nonsupplemented 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 88:4186–4941CrossRefGoogle Scholar
  8. Bensdorp AJ, Cohlen BJ, Heineman MJ, Vandekerckhove P (2007) Intra-uterine insemination for male subfertility. Cochrane Database Syst Rev (3):CD000360Google Scholar
  9. Besselink DE, Farquhar C, Kremer JA, Marjoribanks J, O'Brien P (2008) Cervical insemination versus intra-uterine insemination of donor sperm for subfertility. Cochrane Database Syst Rev (2):CD000317Google Scholar
  10. Boomsma CM, Heineman MJ, Cohlen BJ, Farquhar C (2007) Semen preparation techniques for intrauterine insemination. Cochrane Database Syst Rev (4):CD004507Google Scholar
  11. Bujan L, Hollander L, Coudert M et al (2007) Safety and efficacy of sperm washing in HIF-1-serodiscordant couples where the male is infected: results from the European CREAThE network. AIDS 21(14):1909–1914CrossRefGoogle Scholar
  12. Cantineau AE, Heineman MJ, Cohlen BJ (2007a) Single versus double intrauterine insemination in stimulated cycles for subfertile couples: a systematic review based on a Cochrane review. Hum Reprod 18(5):941–946CrossRefGoogle Scholar
  13. Cantineau AE, Cohlen BJ, Heineman MJ (2007b) Ovarian stimulation protocols (anti-oestrogens, gonadotrophins with and without GnRH agonists/antagonists) for intrauterine insemination (IUI) in women with subfertility. Cochrane Database Syst Rev (2):CD005356Google Scholar
  14. Cantineau AE, Cohlen BJ, Heineman MJ (2009) Intra-uterine insemination versus fallopian tube sperm perfusion for non-tubal infertility. Cochrane Database Syst Rev (2):CD001502Google Scholar
  15. Cantineau AE, Cohlen BJ, Klip H, Heineman MJ, The Dutch IUI Study Group Collaborators (2011) The addition of GnRH antagonists in intrauterine insemination cycles with mild ovarian hyperstimulation does not increase live birth rates – a randomized, double-blinded, placebo-controlled trial. Hum Reprod 26(5):1104–1111Google Scholar
  16. Claman P, Wilkie V, Collins D (2004) Timing intrauterine insemination either 33 or 39 hours after administration of human chorionic gonadotropin yields the same pregnancy rates as after superovulation therapy. Fertil Steril 82:13–16PubMedCrossRefGoogle Scholar
  17. Cohen MR (1962) Intrauterine insemination. Int J Fertil 7:235–240PubMedGoogle Scholar
  18. Cordary D, Braconier A, Guillet-May F, Morel O, Agopiantz M, Callec R (2017) Immobilization versus immediate mobilization after intrauterine insemination: a systematic review and meta-analysis. J Gynecol Obstet Hum Reprod 46(10):747–751PubMedCrossRefGoogle Scholar
  19. Crosignani PG, ESHRE Capri Workshop Group (2009) Intrauterine insemination. Hum Reprod 15(3):265–277Google Scholar
  20. Custers IM, Flierman PA, Maas P, Cox T, Van Dessel TJ, Gerards MH, Mochtar MH, Janssen CA, van der Veen F, Mol BW (2009) Immobilisation versus immediate mobilisation after intrauterine insemination: randomised controlled trial. BMJ 29:339–408Google Scholar
  21. Dankert T, Kremer JA, Cohlen BJ, Hamilton CJ, Pasker-de Jong PC, Straatman H, van Dop PA (2007) A randomized clinical trial of clomiphene citrate versus low dose recombinant FSH for ovarian hyperstimulation in intrauterine insemination cycles for unexplained and male subfertility. Hum Reprod 22(3):792–797PubMedCrossRefGoogle Scholar
  22. Dickey RP, Taylor SN, Lu PY, Sartor BM, Rye PH, Pyrzak R (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(5):1088–1095CrossRefGoogle Scholar
  23. Dorjpurev U, Kuwahara A, Yano Y, Taniguchi T, Yamamoto Y, Suto A, Tanaka Y, Matsuzaki T, Yasui T, Irahara M (2011) Effect of semen characteristics on pregnancy rate following intrauterine insemination. J Med Investig 58(1–2):127–133CrossRefGoogle Scholar
  24. Dorn C (2012) Intrauterine insemination. Gynäkol Endokrinol 10(2):121–131CrossRefGoogle Scholar
  25. Erdem A, Erdem M, Atmaca S, Guler I (2008) Impact of luteal phase support on pregnancy rates in intrauterine insemination cycles: a prospective randomized study. Fertil Steril 91(6):2508–2513PubMedCrossRefGoogle Scholar
  26. Farquhar CM, Liu E, Armstrong S, Arroll N, Lensen S, Brown J (2017) Intrauterine insemination with ovarian stimulation versus expectant management for unexplained infertility (TUI): a pragmatic, openlabel, randomized, controlled, two-centr trial. Lancet 23(17):32406–32406 [Epub vor Druck]Google Scholar
  27. Fouda UM, Sayed AM (2011) Extended letrozole regimen versus clomiphene citrate for superovulation in patients with unexplained infertility undergoing intrauterine insemination: a randomized controlled trial. Reprod Biol Endocrinol 21(9):84CrossRefGoogle Scholar
  28. Goverde AJ, McDonnell J, Vermeiden JP, Schats R, Rutten FF, Schoemaker J (2000) Intrauterine insemination or in-vitro fertilisation in idiopathic subfertility and male subfertility: a randomised trial and cost-effectiveness analysis. Lancet 355:13–18PubMedCrossRefGoogle Scholar
  29. Greb R (2004) Ovarielle Stimulation und intrauterine Insemination (COH-IUI). Gynäkologische Endokrinologie 2(4):194–199CrossRefGoogle Scholar
  30. Green KA, Zolton JR, Schermerhorn SM, Lewis TD, Healy MW, Terry N, DrCherney AH, Hill MJ (2017) Progesterone luteal support after ovulation induction and intrauterine insemination: an updated systematic review and metaanalysis. Fertil Steril 107(4):924–933PubMedCrossRefGoogle Scholar
  31. Helmerhorst FM, Van Vliet HA, Gornas T, Finken MJ, Grimes DA (2005) Intra-uterine insemination versus timed intercourse for cervical hostility in subfertile couples. Cochrane Database Syst Rev (4):CD002809Google Scholar
  32. Jurema MW, Vieira AD, Bankowski B, Petrella C, Zhao Y, Wallach E, Zacur H (2005) Effect of ejaculatory abstinence period on the pregnancy rate after intrauterine insemination. Fertil Steril 84(3):678–681PubMedCrossRefGoogle Scholar
  33. Kahn JA et al (1992) Fallopian tube sperm perfusion: first clinical experience. Hum Reprod 7:19–24PubMedCrossRefGoogle Scholar
  34. Katzorke T (2007) Donogene insemination. Gynäkologe 10:807–812CrossRefGoogle Scholar
  35. Khalil MR, Rasmussen PE, Erb K, Laursen SB, Rex S, Westergaard LG (2001) Homologous intrauterine insemination. An evaluation of prognostic factors based on a review of 2473 cycles. Acta Obstet Gynecol Scand 80(1):74–81PubMedCrossRefGoogle Scholar
  36. Klemetti R, Sevón T, Gissler M, Hemminki E (2010) Health of children born after ovulation induction. Fertil Steril 93(4):1157–1168PubMedCrossRefGoogle Scholar
  37. Kosmas IP, Tatsioni A, Fatemi HM, Kolibianakis EM, Tournaye H, Devroey P (2007) Human chorionic gonadotropin administration vs. luteinizing monitoring for intrauterine insemination timing, after administration of clomiphene citrate: a meta-analysis. Fertil Steril 87:607–612PubMedCrossRefGoogle Scholar
  38. Kupka MS, Franz M, Friese K (2007) Hepatitis, HIV und Kinderwunsch. Gynakologe 10:780–789CrossRefGoogle Scholar
  39. Kyrou D, Fatemi HM, Tournaye H, Devroey P (2010) Luteal phase support in normo-ovulatory women stimulated with clomiphene citrate for intrauterine insemination: need or habit? Hum Reprod 25(10):2501–2506PubMedCrossRefGoogle Scholar
  40. Legro RS, Brzyski RG, Diamond MP, Coutifaris C, Schlaff WD, Casson P, Christman GM, Huang H, Yan Q, Alvero R, Haisenleder DJ, Barnhart KT, Bates GW, Usadi R, Lucidi S, Baker V, Trussell JC, Krawetz SA, Snyder P, Ohl D, Santoro N, Eisenberg E, Zhang H for the NICHD Reproductive Medicine Network* (2014) Letrozole versus clomiphene for infertility in the polycystic ovary syndrome. N Engl J Med 371:119–129PubMedPubMedCentralCrossRefGoogle Scholar
  41. Lewis V, Queenan J Jr, Hoeger K, Stevens J, Guzick DS (2006) Clomiphene citrate monitoring for intrauterine insemination timing: a randomized trial. Fertil Steril 85:401–406PubMedCrossRefGoogle Scholar
  42. Liu J, Li TC, Wang J, Wang W, Hou Z, Liu J (2016) The impact of ovarian stimulation on the outcome of intrauterine insemination treatment: an nalysis of 8893 cycles. BJOG 123(3):70–75PubMedCrossRefGoogle Scholar
  43. Ludwig M (2004) Intrauterine Insemination unter Gonadotropin-Stimulation im GnRH-Antagonisten Protokoll in einem evidenzbasiert selektierten Patientenkollektiv. Geburtsh Frauenheilk 64:1177–1183CrossRefGoogle Scholar
  44. Magnus O, Tollefsrud A, Abyholm T, Purvis K (1991) Effects of varying the abstinence period in the same individuals on sperm quality. Arch Androl 26(3):199–203PubMedCrossRefGoogle Scholar
  45. Marshburn PB, Alanis M, Matthews ML, Usadi R, Papadakis MH, Kullstam S, Hurst BS (2009) A short period of ejaculatory abstinence before intrauterine insemination is associated with higher pregnancy rates. Fertil Steril 93(1):286–288PubMedCrossRefGoogle Scholar
  46. Matorras R, Osuna C, Exposito A, Crisol L, Pijoan JI (2011) Recombinant FSH versus highly purified FSH in intrauterine insemination: systematic review and metaanalysis. Fertil Steril 95(6):1937–1942PubMedCrossRefGoogle Scholar
  47. Matorras R, Rubio K, Iglesias M, Vara I, Exposito A (2017) Risk of pelvic inflammatory disease after intrauterine insemination: a systematic review. Reprod Biomed Online 36(2):164–171. Nov 17 S1472-6483 [Epub vor Druck]PubMedCrossRefGoogle Scholar
  48. Merviel P, Heraud MH, Grenier N, Lourdel E, Sanguinet P, Copin H (2010) Predictive factors for pregnancy after intrauterine insemination (IUI): an analysis of 1038 cycles and a review of the literature. Fertil Steril 93(1):79–88PubMedCrossRefGoogle Scholar
  49. Mol BW, Dijkman B, Wertheim P, Lijmer J, van der Veen F, Bossuyt PM (1997) The accuracy of serum chlamydial antibodies in the diagnosis of tubal pathology: a meta-analysis. Fertil Steril 67:1031–1037CrossRefGoogle Scholar
  50. Montzka et al (1998) Grundlagen der Inseminationsbehandlung. In: Diedrich K (Hrsg) Weibliche Sterilität. Springer, Berlin/Heidelberg/New YorkGoogle Scholar
  51. Nawroth F, Dorn C, Ludwig M (2010) Die intrauterine Insemination. Indikationen und Grenzen. In: Gynäkologische Endokrinologie und Reproduktionsmedizin. Marseille Verlag, MünchenGoogle Scholar
  52. Ombelet W (2003) Semen quality and intrauterine insemination. Reprod Biomed Online 7:485–492PubMedCrossRefGoogle Scholar
  53. Poel N van der, Farquhar C, Abou-Setta AM, Benschop L, Heineman MJ (2010) Soft versus firm catheters for intrauterine insemination. Cochrane Database Syst Rev (11):CD006225Google Scholar
  54. Purcell KJ, Schembri M, Telles TL, Fujimoto VY, Cedars MI (2007) Bed rest after embryo transfer: a randomized controlled trial. Fertil Steril 87:1322–1326PubMedCrossRefGoogle Scholar
  55. Reindollar RH, Regan MM, Neumann PJ, Levine BS, Thornton KL, Alper MM, Goldman MB (2010) A randomized clinical trial to evaluate optimal treatment for unexplained infertility: the fast track and standard treatment (FASTT) trial. Fertil Steril 94(3):888–899PubMedCrossRefGoogle Scholar
  56. Sacks PC, Simon JA (1991) Infectious complications of intrauterine insemination: a case report and literature review. Int J Fertil 36:331–339PubMedGoogle Scholar
  57. Saleh A, Tan SL, Biljan MM, Tulandi T (2000) A randomized study of the effect of 10 minutes of bed rest after intrauterine insemination. Fertil Steril 74:509–511CrossRefGoogle Scholar
  58. Schellen AMCM (1957) Artificial insemination in the human. Elsevier, Amsterdam, S 13Google Scholar
  59. Schröder AK, Pelikan S, Tauchert S, Griesinger G, Felberbaum R, Diedrich K (2004) Prognostische Faktoren für den Erfolg einer intrauterinen Insemination: Eine Evaluation von 1005 Zyklen bei 349 Frauen. Gebirtsh Frauenheilkd 64:1052–1060CrossRefGoogle Scholar
  60. Sims JM (1871) Clinical notes on uterine surgery with special reference to the management of the sterile condition. William Wood, New York, S 165Google Scholar
  61. Song GJ, Herko R, Lewis V (2007) Location of semen collection and time interval from collection to use for intrauterine insemination. Fertil Steril 88:1689–1691PubMedCrossRefGoogle Scholar
  62. Sutcliffe AG, Ludwig M (2007) Outcome of assisted reproduction. Lancet 370(9584):351–359PubMedCrossRefGoogle Scholar
  63. Taerk E, Hughes E, Greenberg C, Neal M, Faghih M, Karnis M (2017) Controlled ovarian hyperstimulation with intrauterine insemination is more successful after rhCG administartion than spontaneous LH surge. J Reprod Infertil 18(3):316–322PubMedPubMedCentralGoogle Scholar
  64. Tanahatoe SJ, Lambalk CB, Hompes PG (2005) The role of laparoscopy in intrauterine insemination: a prospective randomized reallocation study. Hum Reprod 20:3225–3230PubMedCrossRefGoogle Scholar
  65. Tanahatoe S, Lambalk C, McDonnell J, Dekker J, Mijatovic V, Hompes P (2008) Diagnostic laparoscopy is needed after abnormal hysterosalpingography to prevent over-treatment with IVF. Reprod Biomed Online 16(3):410–415PubMedCrossRefGoogle Scholar
  66. Tandler-Schneider A, Sonnenberg-Schwan U, Gingelmaier A, Meurer A, Kremer H, Weigel M, Vernazza P, Schmied B, Klumb S, Schafberger A, Kupka M, Friese K, Brockmeyer NH (2008) Diagnostics and treatment of HIV-affected couples who wish to have children. Eur J Med Res 13(12):546–551PubMedGoogle Scholar
  67. Tetteh RBA (2009) Intrauterine Insemination: Prognosefaktoren für eine Schwangerschaft. Inaugural-Dissertation, Universität BonnGoogle Scholar
  68. Thorn P (2010) Geplante lesbische Familien. Gynäkologische Endokrinologie 8:73–81CrossRefGoogle Scholar
  69. Thorn P, Wischmann T (2010) Leitlinien des BKiD „Psycosoziale Beratung für Frauen und Männer, die eine Kinderwunschbehandlung im Ausland beabsichtigen“. J Reproduktionsmed Endokrinol 7(5):394–402Google Scholar
  70. Van Rumste MME, Custers IM, van der Veen F, van Wely M, Evers JLH (2008) The influence of the number of follicles on pregnancy rates in intrauterine insemination with ovarian stimulation: a meta-analysis. Hum Reprod Update 14:563–570PubMedCrossRefGoogle Scholar
  71. Van Voorhis BJ, Barnett M, Sparks AE, Syrop CH, Rosenthal G, Dawson J (2001) Effect of the total motile sperm count on the efficacy and cost-effectiveness of intrauterine insemination and in vitro fertilization. Fertil Steril 75(4):661–668PubMedCrossRefGoogle Scholar
  72. Van Waart J, Kruger TF, Lombard CJ, Ombelet W (2001) Predictive value of normal sperm morphology in intrauterine insemination (IUI): a structured literature review. Hum Reprod Update 7(5):495–500PubMedCrossRefGoogle Scholar
  73. Verhulst SM, Cohlen BJ, Hughes E, Te Velde E, Heineman MJ (2006) Intra-uterine insemination for unexplained subfertility. Cochrane Database Syst Rev 18(4):CD001838Google Scholar
  74. Vitagliano A, Noventa M, Saccone G, Gizzo S, Vitale SG, Lagana AS, Litta PS, Saccardi C, Nardelli GB, Di Spiezio Sardo A (2017) Endometrial scratch injury before intrauterine insemination: is it time to re-evaluate its value? Evidence from a systematic review and meta-analysis of randomized controlled trals. Fertil Steril 17:31954–31954Google Scholar
  75. Vitorino RL, Grinsztejn BG, de Andrade CA, Hökerberg YH, de Souza CT, Friedman RK, Passos SR (2011) Systematic review of the effectiveness and safety of assisted reproduction techniques in couples serodiscordant for human immunodeficiency virus where the man is positive. Fertil Steril 95(5):1684–1690PubMedCrossRefGoogle Scholar
  76. Weiss NS, van Vliet MN, Limpens J, Hompes PGA, Lambalk CB, Mochtar MH, van der Veen F, Mol BWJ, van Wely M (2017) Endometrial thickness in women undergoing IUI with ovarian stimulation. How thick is too thin? A systematic review and metaanalysis. Hum Reprod 32(5):1009–1018PubMedCrossRefGoogle Scholar
  77. Wischmann T (2008) Psychosoziale Aspekte der Spendersamenbehandlung – eine Übersicht. Geburtsh Frauenheilkd 68:1147–1153CrossRefGoogle Scholar
  78. Wordsworth S, Buchanan J, Mollison J, Harrild K, Robertson L, Tay C, Harrold A, McQueen D, Lyall H, Johnston L, Burrage J, Grossett S, Walton H, Lynch J, Johnstone A, Kini S, Raja A, Templeton A, Bhattacharya S (2011) Clomifene citrate and intrauterine insemination as first-line treatments for unexplained infertility: are they cost-effective? Hum Reprod 26(2):369–375PubMedCrossRefGoogle Scholar
  79. Yavas Y, Selub MR (2004) Intrauterine insemination (IUI) pregnancy outcome is enhanced by shorter intervals from semen collection to sperm wash, from sperm wash to IUI time, and from semen collection to IUI time. Fertil Steril 82:1638–1647PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Deutschland, ein Teil von Springer Nature 2020

Authors and Affiliations

  1. 1.Facharzt-Zentrum für Kinderwunsch, Pränatale Medizin, Endokrinologie und Osteologieamedes MVZ HamburgHamburgDeutschland

Personalised recommendations