Insemination (IUI)
Among all infertile couples, 10-30% have unexplained infertility in which ovulation is normal, there is no pathology in uterine or tubal function and sperm analysis is within normal limits. Treatment algorithm in such patients includes timely coitus, controlled ovarian hyperstimulation (COH), COH with intrauterine insemination (IUI) and assisted reproductive techniques (ART). COH with IUI has been considered as an assisted reproductive technique and forms the baseline treatment in couples with mild to moderate male factor and in couples with the diagnosis of unexplained infertility. IUI is a noninvasive and an economic technique as compared to other assisted reproductive techniques such as IVF, ICSI and GIFT. The chance of spontaneous pregnancy per cycle for couples with unexplained infertility is 2%, while it increases to 10.5-17.9% when patients are treated with IUI with or without COH. The main steps of controlled ovarian hyperstimulation and IUI include the stimulation of patients with either clomiphene citrate (CC) or gonadotropins and sperm preparation techniques including centrifugation of semen and separation of progressive motile sperm from seminal plasma, abnormal sperm cells, leukocytes and other cells with swim-up or gradient techniques. In male infertility, the success rate of IUI depends on the number of motile sperm cells after sperm preparation. Although sperm morphology is another factor affecting fertilization rates in in vitro fertilization cycles, a few studies addresses the impact of sperm morphology in IUI cycles of male factor infertility and unexplained infertility.
Age is another important factor affecting pregnancy rates in infertility treatment. Ovarian reserve decreases by age, which leads to decreased serum inhibin B and increased follicle stimulating hormone (FSH) levels and it has been shown that the success rates of IUI cycles decrease due to advanced age. Advancing age also increases the spontaneous pregnancy loss rates. Mean spontaneous pregnancy loss rate of a woman at 42 is 54.5% whereas this number increases to 74.7% at 45.
Duration and cause of infertility are other important parameters affecting pregnancy rates in IUI cycles. As duration of infertility increases, pregnancy rates after IUI cycles decrease. Patients with a diagnosis of endometriosis have a poorer prognosis than those with a diagnosis of unexplained infertility. Success rate of IUI with or without COH also decreases in mild to moderate endometriosis, which is proposed to be due to an altered follicular environment, impaired oocyte quality, reduced implantation rate and gametotoxicity in the absence of tubal involvement.
IUI is separation of good quality sperms from the semen and deposition of these sperms into the uterine cavity. The procedure selects sperms with better quality, avoids the harmful effects of acidic medium to the sperms and fascilitates the movement of sperms to the fallopian tubes where they can meet the oocyte.
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