Intrauterine insemination (IUI) is the first-choice method
in the treatment of infertility due to moderate
oligoasthenoteratozoospermia, ovulatory dysfunction, surgically treated
stage I or stage II endometriosis, cervical and unexplained infertility, when
at least one fallopian tube is patent. Studies report variable pregnancy (PRs)
and delivery (DRs) rates, and outline many IUI outcome predictors in often
large retrospective series or reduced prospective studies.
The type and extent of fresh sperm quality impairment,
motility, and sperm morphology, and inseminated motile sperm count (IMC) after
sperm preparation are often the most important sperm parameters that predict
IUI success. However, the IMC threshold level, above which IUI can be performed
with acceptable PRs has not been determined yet. Other important male factors
of influence are sexual abstinence before IUI,
Technique of processing fresh
sperm, sperm quality as assessed by computer-assisted sperm analysis, abnormal
hemizona assay, abnormal ionophore-induced acrosome reaction, post-wash total
sperm count, sperm preparation time, the means for prepared sperm insertion
into the female genital tract, time
and number of inseminations, and immediate absolute rest after IUI.
Female positive predictors for successful IUI are women’s
age ≤38 years, good ovarian reserve, higher number of antral and mature
follicles developed, increased endometrial thickness, and good endometrial and
subendometrial vascularization. Female factors influencing PRs negatively are
longer duration of infertility and primary infertility, high number of cycles
performed, and the use of alcohol, coffee, and tea in the past
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