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Intrauterine Insemination

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Practical Manual of In Vitro Fertilization

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Abstract

Intrauterine insemination (IUI) is an assisted reproductive technique that involves the deposition of a processed semen sample in the uterine cavity, overcoming natural barriers to sperm ascent in the female reproductive tract. It is a cost-effective, noninvasive first-line therapy for selected patients with functionally normal tubes, and infertility due to a cervical factor, anovulation, moderate male factor, unexplained factors, immunological factor, and ejaculatory disorders with clinical pregnancy rates per cycle ranging from 10% to 20%. It, however, has limited use in patients with endometriosis, severe male factor infertility, tubal factor infertility, and advanced maternal age ≥35 years. IUI may be performed with or without ovarian stimulation. Controlled ovarian stimulation, particularly with low-dose gonadotropins, with IUI offers significant benefit in terms of pregnancy outcomes compared with natural cycle or timed intercourse, while reducing associated COH complications such as multiple pregnancies and ovarian hyperstimulation syndrome (OHSS). Important prognostic indicators of success with IUI include patient’s age, duration of infertility, stimulation protocol, infertility etiology, number of cycles, timing of insemination, number of preovulatory follicles on the day of hCG, processed total motile sperm >10 million, and insemination count >1 × 106 with >4% normal spermatozoa. Alternative insemination techniques, such as Fallopian tube sperm perfusion, intracervical insemination, and intratubal insemination, provide no additional benefit compared to IUI. A complete couple workup that includes patient history, physical examination, and clinical and laboratory investigations is mandatory to justify the choice in favor of IUI and guide alternative patient management, while individualizing the treatment protocol according to the patient characteristics with a strict cancelation policy to limit multifollicular development may help optimize IUI pregnancy outcomes.

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Authors and Affiliations

  1. Rotunda - The Center for Human Reproduction, Bandra, Rotunda Blue Fertility Clinic and Keyhole Surgery Center, Shivaji Park, Rotunda Fertility Clinic and Keyhole Surgery Center, Andheri, Mumbai, India

    Gautam N. Allahbadia MD, DNB, FNAMS & Rubina Merchant PhD

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  1. Gautam N. Allahbadia MD, DNB, FNAMS
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  2. Rubina Merchant PhD
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Correspondence to Gautam N. Allahbadia MD, DNB, FNAMS .

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  1. , Scientific and Laboratory Director, Reproductive Biology Associates, Atlanta, 30342, Georgia, USA

    Zsolt Peter Nagy

  2. , Sr. Embryologist, Montreal Reproductive Centre, Montreal, H4A 3J3, Québec, Canada

    Alex C. Varghese

  3. Center for Reproductive Medicine, Department of Urology, Cleveland Clinic, Euclid Avenue 9500, Cleveland, 44195, Ohio, USA

    Ashok Agarwal

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Allahbadia, G.N., Merchant, R. (2012). Intrauterine Insemination. In: Nagy, Z., Varghese, A., Agarwal, A. (eds) Practical Manual of In Vitro Fertilization. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-1780-5_31

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