臨床婦人科産科72巻4号

2018年04月発行

増刊号 産婦人科外来パーフェクトガイド─いまのトレンドを逃さずチェック！ 【疾患編2】不妊・不育 《人工授精》

配偶者間人工授精（AIH）

著者： 笠井剛¹

所属機関： ¹山梨大学医学部附属病院生殖医療センター

ページ範囲：P.159 - P.162

外来管理のポイント
❖精液検査のための禁欲期間は2〜7日間である^1）が，AIHを実施する場合3日以内が望ましい．
❖post-coital test（PCT）が良好な場合でもAIHが有効な症例も存在するので，AIHの適応がないわけではない^2）．
❖検体の受け取り，処理，注入時には，患者氏名と検体の氏名のダブルチェックを毎回行う．

参考文献

1）World Health Organization : WHO Laboratory Manual for the Examination and Processing of Human Semen. 5th ed. World Health Organisation Press, Geneva, 2010

2）辰巳賢一，他 : Ⅱ．一般不妊診療の実際，効果的AIH，新版　今日の不妊治療．pp81─87，医歯薬出版，2013

3）van der Westerlaken LA, et al : Evaluation of pregnancy rates after intrauterine insemination according to indication, age, and sperm parameters. J Assist Reprod Genet 15 : 359─364, 1998

4）Dickey RP, et al : Comparison of the sperm quality necessary for successful intrauterine insemination with World Health Organization threshold values for normal sperm. Fertil Steril 71 : 684─689, 1999

5）Berg U, et al : Effect of motile sperm count after swim-up on outcome of intrauterine insemination. Fertil Steril 67 : 747─750, 1997

6）Miller DC, et al : Processed total motile sperm count correlates with pregnancy outcome after intrauterine insemination. Urology 60 : 497─450, 2002

7）吉村𣳾典，男性不妊症に対する生殖補助医療技術の応用に対するガイドラインに関する研究，厚生科学研究─生殖補助医療の適応に関する研究─．pp603─614, 2002

8）Shibahara H, et al : Prediction of pregnancy by intrauterine insemination using CASA estimates and strict criteria in patients with male factor infertility. Int J Androl 27 : 63─68, 2004

9）Van Waart J, et al : Predictive value of normal sperm morphology in intrauterine insemination（IUI） : a structured literature review. Hum Reprod Update 7 : 495─500, 2001

10）Guzick DS, et al : Efficacy of superovulation and intrauterine insemination in the treatment of infertility. National Cooperative Reproductive Medicine Network. N Engl J Med 340 : 177─183, 1999

11）Balasch J : Gonadotrophin ovarian stimulation and intrauterine insemination for unexplained infertility. Reprod Biomed Online 9 : 664─672, 2004

12）Gregoriou O, et al : Controlled ovarian hyperstimulation with or without intrauterine insemination for the treatment of unexplained infertility. Int J Gynaecol Obstet 48 : 55─59, 1995

13）CQ319．産婦人科診療ガイドライン─婦人科外来編，2017

14）National Collaborating Centre for Women's and Children's Health（UK） : Fertility : assessment and treatment for people with fertility problems. Royal College of Obstetricians＆Gynaecologists, London, 2013

15）柴原浩章 : 症例から学ぶ生殖医学，抗精子抗体．日産婦会誌57 : N325─N331, 2005

16）Cantineau AE, et al : Synchronised approach for intrauterine insemination in subfertile couples. Cochrane Database Syst Rev （12） : CD006942, 2014

17）Cantineau AE, et al : Single versus double intrauterine insemination in stimulated cycles for subfertile couples. Cochrane Database Syst Rev（4） : CD006942, 2010

18）Arab-Zozani M, et al : Single versus double intrauterine insemination（IUI）for pregnancy : A systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 215 : 75─84, 2017

19）Martinez AR,et al : Intrauterine insemination does and clomiphene citrate does not improve fecundity in couples with infertility due to male or idiopathic factors : a prospective, randomized, controlled study. Fertil Steril 53 : 847─853, 1990

20）Arici A, et al : Evaluation of clomiphene citrate and human chorionic gonadotropin treatment : a prospective, randomized, crossover study during intrauterine insemination cycles. Fertil Steril 61 : 314─318, 1994

21）Jurema MW, et al : Effect of ejaculatory abstinence period on the pregnancy rate after intrauterine insemination. Fertil Steril 84 : 678─681, 2005

22）Yavas Y, et al : Intrauterine insemination（IUI） pregnancy outcome is enhanced by shorter intervals from semen collection to sperm wash, from sperm wash to IUI time, and from semen collection to IUI time. Fertil Steril 82 : 1638─1647, 2004

23）Boomsma CM, et al : Semen preparation techniques for intrauterine insemination. Cochrane Database Syst Rev（4） : CD004507, 2007

24）van der Poel N, et al : Soft versus firm catheters for intrauterine insemination. Cochrane Database Syst Rev（11） : CD006225, 2010

25）Saleh A, et al : A randomized study of the effect of 10 minutes of bed rest after intrauterine insemination. Fertil Steril 74 : 509─511, 2000

26）Suzuki K, et al : Life-table analysis of artificial insemination pregnancy rates for couples with male factor and idiopathic infertility. Reprod Med Biol 3 : 27─31, 2004

27）朝田嘉一，他 : 当院における過去10年間の卵管卵巣膿瘍62例に関する検討．関東連合産婦会誌48 : 405─410, 2011