IUI防止LH surge並無法有效提高懷孕率

人工受孕COH過程中約有20-30%發生LH surge

人工受孕(IUI)使用GnRHantagonist防止LH surge並無法有效提高懷孕率

IUI黃體期補充黃體素並無法有效提高懷孕率

人工受孕之懷孕率僅5-12%

總活動精蟲<1000萬懷孕率會明顯下降

http://humupd.oxfordjournals.org/content/15/3/265.full

Intrauterine insemination

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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 andin 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.

Table IV

Pregnancy rate per cycle and number needed to treat (NNT) per cycle

Treatment	Pregnancy rate per cycle	NNT	95% CI	Source of results
IUI	5	32	(12, −46)	Guzick et al. (1999), Martinez et al. (1990) and Steures et al. (2007)
CC/IUI*	7	14	(7, −100)	Deaton et al. (1990)
FSH/IUI	4	−25	(15, −7)	Steures et al. (2006)
FSH/IUI	12	11	(9, 16)	Guzick et al. (1999)
IVF	31	4	(3, 7)	Hughes et al. (2004)

• *Pregnancy rate per cycle is from Reindollar et al. (2007). NNT is from Deaton et al. (1990) before crossover.