Intrauterine Insemination unter Gonadotropin-Stimulation im GnRH-Antagonisten - Protokoll in einem evidenzbasiert selektierten Patientenkollektiv

Zusammenfassung

In prospektiver Art wurden 64 Patientinnen nach einem standardisierten Protokoll ausgewählt und in 133 Inseminationszyklen behandelt. Das durchschnittliche Alter betrug 33,05 ± 3,92 Jahre bei einer mittleren Kinderwunschdauer von 2,63 ± 1,49 Jahren. Etwa ⅔ der Patientinnen wiesen eine primäre Sterilität auf. Es konnten 32 Schwangerschaften erzielt werden. Die kumulative Schwangerschaftsrate pro Patientin lag bei 41 %, die kumulative weiterlaufende Schwangerschaftsrate bei 30 %. Unabhängig davon, ob ein Tubenfaktor per laparoscopiam abgeklärt und unauffällig war, oder aber ob aufgrund der vorangehenden Anamnese ein Tubenfaktor unwahrscheinlich war, unterschied sich die Schwangerschaftsrate nicht. Somit kann in individuellen Fällen - bei komplettem Fehlen von Risikofaktoren - offenbar auf die in jedem Falle durchgeführte Laparoskopie verzichtet werden. Die Spermienzahlen im Nativejakulat vor Insemination spielten keine Rolle für den Erfolg. Wesentlich war die Absolutzahl der progressiv motilen Spermien (nach WHO A und B) im aufbereiteten Ejakulat, die einen signifikanten Einfluss auf das Eintreten einer Schwangerschaft hatten. Das Stimulationsprotokoll mit rekombinantem humanen (r-h)FSH in einem Pen (Puregon Pen) unter gleichzeitiger Verwendung eines GnRH-Antagonisten (Cetrotide® 0,25 mg) im Mehrfachdosisprotokoll erlaubte ein optimales Timing der Insemination. Zusammenfassend kann also die gezielte Patientenselektion unter Einsatz innovativer Stimulationsverfahren einen hohen Erfolg in der Inseminationsbehandlung garantieren helfen. Dies gibt der Inseminationsbehandlung einen gerechtfertigten Stellenwert in der Behandlung des Kinderwunschpaares.

Abstract

Sixty-four patients were prospectively counselled and selected for intrauterine insemination. All patients were counselled and selected based on a standardized scheme and treated over 133 insemination cycles. Mean age was 33.05 ± 3.92 years with a mean duration of infertility of 2.63 ± 1.49 years. Around ⅔ of patients suffered from primary infertility. 32 pregnancies could be established. The cumulative pregnancy rate was 41 % per patient, the cumulative ongoing pregnancy rate was 30 %. The pregnancy rate was comparable, irrespective of whether a tubal factor had been excluded by laparoscopy or not, as no previously known factors were present which presented as a tubal risk factor. Therefore, in individual cases - when there is complete absence of risk factors for tubal infertility - it is possible to skip the laparoscopy. The sperm count before semen preparation did not influence the success rate. The absolute number of progressively motile sperms (WHO A and B), however, had a significant influence on success rates. The stimulation protocol always included recombinant human (r-h)FSH in a pen device (Puregon Pen). All stimulation procedures were done using a multiple dose antagonist protocol with 0.25 mg daily Cetrotide®. This allowed optimal timing of intrauterine insemination after hCG administration (around 4 - 6 hours before ovulation) and contributed significantly to the success rate in this cohort of patients. In conclusion, the evidence-based selection of patients as well as the use of innovative stimulation protocols makes intrauterine insemination a very successful treatment. Intrauterine insemination, therefore, has its place in infertility treatment.

Intrauterine Insemination - rekombinantes humanes FSH - GnRH-Antagonist

Intrauterine insemination - recombinant human FSH - GnRH antagonist

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