29 Intrauterine Insemination |
211 |
References
1.\Sacks PC, Simon JA. Infectious complications of intrauterine insemination: a case report and literature review. Int J Fertil. 1991;36(6):331–9.
2.\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.
3.\Guzick DS, Carson SA, Coutifaris C, Overstreet JW, Factor-Litvak P, Steinkampf MP, et al. Effcacy of superovulation and intrauterine insemination in the treatment of infertility. N Engl J Med. 1999;340(3):177–83.
4.\Reindollar RH, Regan MM, Neumann PJ, Levine B-S, Thornton KL, Alper MM, et al. A randomized clinical trial to evaluate optimal treatment for unexplained infertility: the fast track and standard treatment (FASTT) trial. Fertil Steril. 2010;94(3):888–99.
5.\Weiss NS, Nahuis MJ, Bordewijk E, Oosterhuis JE, Smeenk JM, Hoek A, et al. Gonadotrophins versus clomifene citrate with or without intrauterine insemination in women with normogonadotropic anovulation and clomifene failure (M-OVIN): a randomised, two-by-two factorial trial. Lancet. 2018;391(10122):758–65.
6.\Rahman SM, Karmakar D, Malhotra N, Kumar S. Timing of intrauterine insemination: an attempt to unravel the enigma. Arch Gynecol Obstet. 2011;284(4):1023–7.
7.\Vichinsartvichai P, Traipak K, Manolertthewan C. Performing IUI simultaneously with hCG administration does not compromise pregnancy rate: a retrospective cohort study. J Reprod Infertil. 2018;19(1):26–31.
8.\Boomsma CM, Heineman MJ, Cohlen BJ, Farquhar C. Semen preparation techniques for intrauterine insemination. Cochrane Database Syst Rev. 2007;(4):CD004507.
9.\Zafer M, Horvath H, Mmeje O, van der Poel S, Semprini AE, Rutherford G, et al. Effectiveness of semen washing to prevent human immunodefciency virus (HIV) transmission and assist pregnancy in HIV-discordant couples: a systematic review and meta-analysis. Fertil Steril. 2016;105(3):645–55.
10.\Smith JF, Eisenberg ML, Millstein SG, Nachtigall RD, Sadetsky N, Cedars MI, et al. Fertility treatments and outcomes among couples seeking fertility care: data from a prospective fertility cohort in the United States. Fertil Steril. 2011;95(1):79–84.
11.\Custers IM, Steures P, Hompes P, Flierman P, van Kasteren Y, van Dop PA, et al. Intrauterine insemination: how many cycles should we perform? Hum Reprod. 2008;23(4):885–8.
12.\Practice Committee of the American Society for Reproductive Medicine. Evidence-based treatments for couples with unexplained infertility: a guideline. Fertil Steril. 2020;113(2):305–22.
Данная книга находится в списке для перевода на русский язык сайта https://meduniver.com/
Chapter 30
Assisted Reproductive Technology
Nigel Pereira and Zev Rosenwaks
Case
A 35-year-old gravida 2 para 0 woman presents to the of ce for the evaluation of 18-month history of involuntary infertility. Her anti-Mullerian hormone (AMH) and cycle day 2/3 follicle-stimulating hormone (FSH) levels 2 years prior to presentation were 0.04 ng/mL and 19.8 mIU/mL, respectively. Her prior two conceptions occurred naturally but resulted in biochemical pregnancies. Her partner is a 33-year- old gentleman with no pertinent urologic history, except for isolated teratozoospermia on semen analysis. She underwent three IVF cycles at another institution, yielding a single cryopreserved (2pn) zygote. Her current evaluation was signi cant for an AMH of 0.08 ng/mL and cycle day 2 FSH of 48.5 mIU/mL and LH of 18 mIU/ mL. How does a physician approach this clinical presentation?
Background
The diagnosis and treatment of most medical conditions are individual-based i.e., a single individual undergoes treatment, and successful outcome hinges on the patient-physician relationship and that individual’s compliance to treatment. In contrast, infertility treatment involves a couple whose general and reproductive health
N. Pereira
Reproductive Medicine and Ob/Gyn, The Ronald Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Medical College of Cornell University, New York, NY, USA e-mail: nip9060@med.cornell.edu
Z. Rosenwaks (*)
Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Medical College of Cornell University, New York, NY, USA
e-mail: zrosenw@med.cornell.edu
© Springer Nature Switzerland AG 2023 |
213 |
P. H. Chung, Z. Rosenwaks (eds.), Problem-Focused Reproductive Endocrinology and Infertility, Contemporary Endocrinology, https://doi.org/10.1007/978-3-031-19443-6_30
214 |
N. Pereira and Z. Rosenwaks |
is often evaluated by multiple medical providers in parallel. Optimal fertility treatment requires collaboration within the couple, between the couple and medical providers, sometimes the involvement of an embryology or andrology laboratory. The management of infertility has rapidly evolved over the past four decades, and in some instances, there has been an accelerated adoption of certain fertility treatments despite limited clinical evidence. In this chapter, we review the epidemiology and diagnostic workup of female infertility. We speci cally focus on Assisted Reproductive Technology (ART) as a therapeutic strategy for infertility. We also present the clinical outcomes associated with ART and also briefy appraise their safety.
Epidemiology
Infertility is commonly de ned as the failure to conceive after 1 year of unprotected intercourse and is thought to affect approximately 15% of reproductive age couples worldwide. Human reproductive ef ciency is relatively inef cient when compared to other species, including nonhuman primates. Reproductive ef ciency in normally fertile couples is estimated at approximately 20% per menstrual cycle, which suggests that 85% of couples should conceive within 1 year. Therefore, a couple should undergo a fertility evaluation once the 1-year threshold has been met. However, a workup can be initiated sooner in women >35 years or age or those with pertinent medical and/or gynecologic ndings. It is important to note that many couples undergoing infertility treatment may be sub-fertile, and not truly sterile. Therefore, a proportion of sub-fertile couples may conceive without any intervention.
Evaluation
The initial evaluation of infertility begins with a comprehensive history and physical examination of the female partner. For the purpose of this chapter, we will focus on the female workup. However, the male partner may require a complete urologic evaluation based on clinical history or abnormal semen analyses. A female fertility evaluation should include the following:
\(a)\ Thorough developmental, medical, surgical, family, social, and sexual history. Surgical procedures such as ovarian cystectomy, hernia repairs, or pelvic surgery can impair fertility or ovarian reserve, and should therefore be reviewed. Any family history, particularly parental history of infertility or fertility treatments should be elicited. The social history should comprise a thorough review of tobacco or alcohol consumption, as well as use of recreational drugs. Eliciting history of any prior sexually transmitted infections, pelvic infections, pregnan-
Данная книга находится в списке для перевода на русский язык сайта https://meduniver.com/
30 Assisted Reproductive Technology |
215 |
cies with the current or previous partners, and incorrect patterns of timing intercourse generally comprises the sexual history. Given the potential adverse effects that many medications can have on fertility, all medications used by a patient, including dosage and route of administration should be noted in detail. Furthermore, any occupational exposure to pesticides, herbicides, radiation or industrial solvents should be investigated.
\(b)\ Meticulous physical examination includes an assessment of body habitus, breast development, external genital examination, and an internal bimanual pelvic examination.
\(c)\ Uterine cavity and tubal patency evaluation.
\(d)\ Ovulatory status based on menstrual cycle regularity or measurement of a mid- luteal serum progesterone >3 ng/mL. In anovulatory women, serum prolactin and thyroid-stimulating hormone should also be measured.
\(e)\ Ovarian reserve testing, which includes antral follicle counts via transvaginal ultrasonography, or measurements of anti-Mullerian hormone (AMH) and cycle day 2/3 follicle-stimulating hormone (FSH).
\(f)\ Semen analysis with a concentration of 15 million sperm per milliliter, >40% motility, and at least 4% normal morphology by strict Kruger criteria. Given the inherent biological fuctuations between semen samples, a minimum of two samples should be examined.
\(g)\ Laparoscopy may aid in the assessment of endometriosis, especially in women with a history of dysmenorrhea, pelvic pain, or endometriomas. While most data suggest that laparoscopy is not strictly necessary for infertility evaluation, each physician should carefully assess the bene ts versus risks on an individual patient basis.
Diagnostic methods such as post-coital tests and endometrial biopsies were widely utilized in the evaluation of infertility. However, several large-scale studies have demonstrated that these methods lack accuracy and reproducibility, and often fail to distinguish between infertile and fertile women.
Couples can be classi ed into one of four categories based on the initial workup: female factor (~35% of cases), male factor (~30% of cases), and combined female and male factor (~20%). Couples who do not have a clear cause of infertility comprise the remaining 15% of cases in a category called unexplained infertility, which by de nition, is a diagnosis of exclusion. Some large retrospective studies have reported that unexplained infertility may comprise up to 30% of all infertility cases; however, the incidence of these cases depends on the criteria used to de ne unexplained infertility. Given that there is no universal consensus as to which exact tests constitute a standard fertility evaluation, and no de ned universal protocols for the diagnosis of unexplained infertility, the prevalence of unexplained infertility varies largely in the medical literature. The categorization of infertility types also aids in expediting treatment options, given that the likelihood of achieving a live birth without treatment decreases with increasing age of the female as well as duration of infertility.