Insemination

1. Dr Aniruddha Malpani, MD
Malpani Infertility Clinic
www.drmalpani.com

2. IUI – the basics
Eggs plus sperm = baby !
1. Superovulate
2. Time ovulation accurately
3. Process sperm ( to improve their
quality)
4. Insert sperm into the uterus with a
catheter

3. The key to success ?
 What catheter you use ?
 How many times you do the insemination ?
 ( double versus single)
 What sperm preparation technique you use ?
 wash or swim up or gradient
 How you superovulate ?
 Letrozole or clomid or HMG

4. Superovulate ( grow more eggs)
Clomid ? Letrozole ?
HMG ?
FSH ?
Recombinant ?
How many follicles ?

5. Time ovulation
 Monitor with ultrasound scans
 Follicle size and endometrial thickness and
texture
 Optimal follicle size ?
 Monitor with urinary LH strips
 HCG injection for inducing ovulation
 ? GnRH analog for inducing ovulation

6. Timing of IUI
 Before ovulation ?
 After ovulation ?
 How many times ?
 Single ?
 Double
 Intercourse ?

7. How to process the sperm ?
 Swim up ?
 Wash ?
 Culture medium ?
 With HEPES ?
 Add Pentoxyfylline to improve sperm motility ?
 Gradient density centrifugation ?
 Motile sperm count ?
 Volume ?

8. Technique of IUI
 Which catheter ?
 Soft ?
 Rigid ?
 Does the brand matter ?
 Indian ? Foreign ?
 Location of catheter tip ?
 Fundal ?
 Bed rest after IUI ?

9. The key to success ?
 What catheter you use ?
 How many times you do the insemination ?
 ( double versus single)
 What sperm preparation technique you use ?
 wash or swim up or gradient
 How you superovulate ?
 Letrozole or clomid or HMG

10. The secret to IUI success ?
Patient selection !

11. Major problem with IUI
Easy to do
Inexpensive
Everyone wants to do it
Done for all the wrong reasons

12. Unrealistic expectations
• Patients
–Eggs plus sperm = baby
–Expect instant success
–Get upset and frustrated
–Lose confidence in doctors

13. Unrealistic expectations
• Doctors
–Do not understand limitations of IUI
–Overpromise – claim success rates of
20%
–Too many attempts

14. Dangers
Multiple pregnancy
Infection ( poorly prepared sperm)
OHSS

15. Best results when
Young patient
Good sperm
Normal tubes
Normal uterus
Unexplained infertility

16. Poor results
Poor sperm count
Older women
Poor ovarian reserve
Damaged tubes
Many previous failed IUI cycles

17. Real life problems
 Patients run around from clinic to scan
center to lab
 Poor documentation
 Sperm sample – not seen by doctor or shown
to patient
 Long time delays after sperm is prepared
 Not on a Sunday !

18. Take home messages
Select patients carefully
Keep records and analyse them !
Do everything under one roof
Do not do more than 4 IUIs
Know when to refer for IVF