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Worldwide intrauterine insemination (IUI) is still one of the most applied treatment options for couples with infertility for various reasons. The rationale for performing IUI is to increase the number of motile sperm with normal morphology at the site of fertilization at the right moment. With the use of sperm preparation techniques applied in in vitro fertilization (IVF), side effects such as severe cramping or infections hardly ever occur any more.
This chapter focuses on the indications for intrauterine insemination (IUI) in combination with mild ovarian hyperstimulation (MOH), its methods and risks. Optimal timing of the insemination is a crucial factor in IUI programs. After ovulation oocytes should be fertilized within several hours. Inseminated sperm (bypassing the cervix which acts as a reservoir for spermatozoa) has a limited period of survival, and sperm should therefore not be inseminated too early. When MOH is applied in IUI programs, one should strive after multifollicular growth of two to three dominant follicles to obtain the highest probability of conception with reasonable risks. When multiple pregnancies are kept to a minimum, MOH/IUI is more cost-effective compared with in vitro fertilization (IVF). Gonadotropins are the most effective drugs and should be offered in a low-dose, step-up protocol. Future randomized trials should investigate the cost-effectiveness of luteal support.
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