Intrauterine Insemination, IVF/ICSI

Abstract

Infertility is defined as the inability to conceive after one year despite regular intercourse. The need for treatment and treatment option are determined by the evaluation process that starts after this stage. Treatment mainly includes ovarian stimulation followed by timed intercourse, intrauterine insemination (IUI), and in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI). Choosing the appropriate patient and appropriate treatment method is critical here and is based on many factors. Maternal age and infertility etiology are the main determinants of treatment selection. As important as it is to think about IVF/ICSI selection quickly in patients over 38 years of age, it is equally important to switch to assisted reproductive techniques without waiting in the presence of very low sperm parameters. An inappropriate indication will fail even if the treatment is done in the best way. Appropriate patient selection and giving enough time to the patient in the treatment stages will increase success. In the presented article, IUI and IVF/ICSI patient selection criteria will be evaluated according to the causes of infertility. Here, the order in which the patient will be evaluated and the steps to be taken on the way to IVF/ICSI in the treatment of staged infertility will be evaluated in detail and descriptively.

Keywords

• Infertility
• intrauterine insemination
• in vitro fertilization
• treatment

Intrauterin Inseminasyon, IVF/ICSI

Abstract

İnfertilite düzenli ilişkiye rağmen bir yılın sonunda gebe kalamama olarak tanımlanmaktadır. Bu aşamadan sonra başlayan değerlendirme süreci ile tedavi ihtiyacı ve tedavi seçeneği belirlenmektedir. Tedavi temel olarak over stimulasyonunu takiben zamanlı ilişki, intrauterin inseminasyon (IUI) ve in vitro fertilizasyon (IVF)/intrasitoplazmik sperm enjeksiyonunu (intracytoplasmic sperm injection, ICSI)’nu içermektedir. Burada uygun hasta ve uygun tedavi yönteminin seçilmesi kritiktir ve birçok faktöre bağlıdır. Anne yaşı ve infertilite etiyolojisi tedavi seçiminde ana belirteçtir. 38 yaş üzeri hastada hızla IVF/ICSI seçimi hakkında düşünmek ne kadar önemli ise çok düşük sperm parametreleri varlığında beklemeden yardımcı üreme tekniklerine geçmek de o kadar önemlidir. Uygun olmayan endikasyon tedavi en iyi şekilde bile yapılsa başarısız olacaktır. Uygun hasta seçimi ve tedavi aşamalarında hastaya yeterli süre verilmesi başarıyı artıracaktır. Sunulan makalede infertilite nedenlerine göre IUI ve IVF/ICSI hasta seçim kriterleri değerlendirilecektir. Burada hasta değerlendirmesinin hangi sıra ile yapılacağı ve basamaklı infertilite tedavisinde IVF/ICSI’ya giden yolda geçilmesi gereken basamaklar detaylı ve açıklayıcı olarak değerlendirilecektir.

Keywords

• İnfertilite
• intrauterin inseminasyon
• in vitro fertilizasyon
• tedavi

References

1. Practice Committee of the American Society for Reproductive Medicine. Fertility evaluation of infertile women: a committee opinion. Fertil Steril. 2021;116(5):1255-65.
2. Zegers-Hochschild F, Adamson GD, Dyer S, Racowsky C, de Mouzon J, Sokol R, et al. The international glossary on infertility and fertility care. Fertil Steril. 2017;108(3):393-406.
3. Van Voorhis BJ, Barnett M, Sparks AE, Syrop CH, Rosenthal G, Dawson J. Effect of the total motile sperm count on the efficacy and cost-effectiveness of intrauterine insemination and in vitro fertilization. Fertil Steril. 2001;75(4):661-8.
4. Bhattacharya S, Harrild K, Mollison J, Wordsworth S, Tay C, Harrold A, et al. Clomifene citrate or unstimulated intrauterine insemination compared with expectant management for unexplained infertility: pragmatic randomised controlled trial. BMJ. 2008;337:a716
5. Reindollar RH, Regan MM, Neumann PJ, Levine BS, Thornton KL, Alper MM, et al. A Randomized clinical trail to evaluate optimal treatemnt for unexplained infertility: the fast track and standard treatment (FASTT) trial. Fertil Streril. 2010;94(3):888-99.
6. Hunault CC, Laven JSE, van Rooij IAJ, Eijkemans MJC, te Velde ER, Habbema JD. Prospective validation of two models predicting pregnancy leading to live birth among untreated subfertile couples. Hum Reprod. 2005;20(6):1636-41.
7. van der Steeg JW, Steures P, Eijkemans MJ, Habbema JD, Hompes PG, Broekmans FJ, et al. Pregnancy is predictable: a large-scale prospective external validation of the prediction of spontaneous pregnancy in subfertile couples. Hum Reprod. 2007;22(2):536-42.
8. Custers IM, Steures P, Van der Steeg JW, van Dessel TJ, Bernardus RE, Bourdrez P, et al. External validation of a prediction model for an ongoing pregnancy after intrauterine insemination. Fertil Steril. 2007;88(2):425-31.

9. Danhof NA, Wang R, van Wely M, van der Veen F, Mol BWJ, Mochtar MH. IUI for unexplained infertility-a network meta-analysis Hum Reprod Update. 2020;26(1):1-15.
10. Ayeleke RO, Asseler JD, Cohlen BJ, Veltman-Verhulst SM. Intra-uterine insemination for unexplained subfertility. Cochrane Database Syst Rev. 2020;3(3):CD001838.
11. Custers IM, König TE, Broekmans FJ, Hompes PG, Kaaijk E, Oosterhuis J, et al. Couples with unexplained subfertility and unfavorable prognosis: a randomized pilot trial comparing the effectiveness of in vitro fertilization with elective single embryo transfer versus intrauterine insemination with controlled ovarian stimulation. Fertil Steril. 2011;96(5):1107-11.e1.
12. Bensdorp AJ, Tjon-Kon-Fat RI, Bossuyt PM, Koks CA, Oosterhuis GJ, Hoek A, et al. Prevention of multiple pregnancies in couples with unexplained or mild male subfertility: randomised controlled trial of in vitro fertilisation with single embryo transfer or in vitro fertilisation in modified natural cycle compared with intrauterine insemination. BMJ. 2015;350:g7771.
13. Nandi A, Bhide P, Hooper R, Gudi A, Shah A, Khan K, et al. Intrauterine insemination with gonadotropin stimulation or in vitro fertilization for the treatment of unexplained subfertility: a randomized controlled trial. Fertil Steril. 2017;107(6):1329-35.e2.
14. Wang R, Danhof NA, Tjon-Kon-Fat RI, Eijkemans MJ, Bossuyt PM, Mochtar MH, et al. Interventions for unexplained infertility: a systematic review and network meta-analysis. Cochrane Database Syst Rev. 2019;9(9):CD012692.
15. Bahadur G, Homburg R, Bosmans JE, Huirne JAF, Hinstridge P, Jayaprakasan K, et al. Observational retrospective study of UK national success, risks and costs for 319,105 IVF/ICSI and 30,669 IUI treatment cycles. BMJ Open. 2020;10(3):e034566.
16. Pandian Z, Gibreel A, Bhattacharya S. In vitro fertilisation for unexplained subfertility. Cochrane Database Syst Rev. 2012;(4):CD003357.
17. Homburg R. IUI is a better alternative than IVF as the first-line treatment of unexplained infertility Reprod Biomed Online. 2022;45(1):1-3.
18. Buckett W, Sierra S. The management of unexplained infertility: an evidence-based guideline from the Canadian Fertility and Andrology Society. Reprod Biomed Online. 2019;39(4):633-40.
19. Practice Committee of the American Society for Reproductive Medicine (2020) Evidence-based treatments for couples with unexplained infertility: a guideline. Fertil Steril. 113(2):305-22.
20. Nandi A, Raja G, White D, Tarek ET. Intrauterine insemination + controlled ovarian hyperstimulation versus in vitro fertilisation in unexplained infertility: a systematic review and meta-analysis. Arch Gynecol Obstet. 2022;305(4):805-24.
21. Goldman MB, Thornton KL, Ryley D, Alper MM, Fung JL, Hornstein MD, et al. A randomized clinical trial to determine optimal infertility treatment in older couples: the Forty and Over Treatment Trial (FORT-T). Fertil Steril. 2014;101(6): 1574-81.e1-2.
22. Cohlen B, Bijkerk A, Van der Poel S, Ombelet W. IUI: review and systematic assessment of the evidence that supports global recommendations. Hum Reprod Update. 2018;24(3):300-19.