[Significance of insemination in the era of IVF and ICSI].

The first step in the treatment of infertile couples in most cases is the method of intrauterine insemination (IUI), as it is less invasive than the extracorporeal procedures of ART (artificial reproductive techniques). However, in comparison to the methods of in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI), IUI is discussed controversially, especially in terms of effectiveness and efficacy, for the result of IUI is influenced by multiple factors. Thus, not only methodological aspects, e.g. preparation of and insertion of the prepared sperm into the genital tract, time of insemination in relation to ovulation, but also the reasons for female subfertility and sperm quality have to be taken into consideration.Based on current literature and practical experience there are some prerequisites to be fulfilled to recommend IUI: It should only be applied in couples with female age under 40 years, known tubal status, short period of infertility and on the male side unrestricted or only slightly restricted sperm parameters, ideally normozoospermia. IUI is the method of choice versus timed intercourse and should be set up together with gonadotrophin ovarian stimulation. The step up to ART procedures should follow after four cycles of unsuccessful IUI at the latest. In terms of cost-effectiveness, efficacy and benefit of detailed information on germ cell material and embryo development, it must rather be recommended to switch to IVF/ICSI as soon as possible.