The document details intrauterine insemination (IUI) as a less invasive fertility treatment option, highlighting its advantages and indications for use. It discusses semen preparation techniques, timing for IUI, and factors influencing success rates, including male subfertility and female age. The effectiveness of IUI compared to other fertility treatments is examined, along with associated risks and complications.

1. IInnttrraaUUtteerriinnee IInnsseemmiinnaattiioonn
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2. Advantage
•Easy to perform
•Training is easy
•Less invasive
•Risks are minimal
•Quality control possible
•Costs are minimal
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3. Items Addressed
• What is IUI.
•Indications.
•Effectiveness.
•Cost Effectiveness.
• Factors affecting success rate.
•Advantages and complications.
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4. The rationale is bypassing the
cervical-mucus barrier and increasing
the number of motile spermatozoa
with a high proportion of normal
forms at the site of fertilization.
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5. Semen Preparation Techniques
-Swim up.
-Albumin
-Percoll
-Minipercoll
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6. The washing procedures are
necessary to remove
prostaglandins, infectious agents,
antigenic proteins, non-motile
spermatozoa, leucocytes and
immature germ cells.
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7. Timing of IUI
• Basal Body Temperature
• LH Surge ( urine/serum)
• US

8. Sites of insemination
• Intrauterine (IUI)
• Intracervical (ICI)

9. Indications
• Male factor subfertility
• Unexplained infertility
• Endometriosis.
• Combined ovulatory and ♂ factor
infertility.
• Cervical and immunological infertility
• Sexual dysfunction infertility.

10. Male Factor Subfertility
In long standing infertility caused
by reduced sperm quality
expectant treatment seems to be
disappointing with a spontaneous
conception rate of only 2% per
cycle.
Collins J A et al. Fertil Steril; 1995, 64:22-28
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11. The lower reference limit for semen analysis
5th centile 95%
CI
Volume 1,5ml (1.4-1.7
P H 7.2
Motility 40% (38-42)
Progressive
32% (31-34)
Non progressive
Immotile
Vitality
(intact membrane)
58% (55-63)
Count 15X106 12-16X10 6
Normal forms 4% (3-4)
WHO Lab Manual of Human Semen 2010
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12. Male factor Infertility (OAT)
-Oligozoospermia (O)
-Asthenozoospermia (A)
-Tratozoospermia (T)
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13. Male subfertility
In male subfertility IUI with
or without COH a pregnancy
rate of 10-18% per cycle has
been reported.
-Stone BA et al 1999. Am. J Obstet Gynecol, 180:1522-1534
- Ombelet W et al 1995,Hum. Reprod. 10 (Suppl. 1):90-120
- Ombelet W et al 1997. Hum. Reprod. 12:1458-1463
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14. Male subfertility
A Cochrane review showed
that IUI is superior to TI,
both in natural and in cycles
with CoH.
Cohlen BJ et al 2000. (Cochrane Review)
Cochrane library, issue 4, update software, Oxford.
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15. (cumulative ongoing PR of 21.9%
after three IUI cycles).
-Centole GM 1997. J. Androl; 18:448-453
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16. Infertility work -up
No tubal factor
HSG, Laparoscopy, HSCS..
Washing procedure
IMC< 1 million IMC> 1 million
IMC< 1 million
Morphology <5%
IUI 4x
IVF
< 30 % or no fertilization
ICSI
Proposed algorithm of male subfertility treatment at the Genk Institute for fertility Technology (ICM, insemination motile count of the
number of motile spermatozoa after washing procedure; HSG, hysterisalpingography; HSCS, hysatero-salpingo-contrast-sonography)
Ombelet W et al 2008). ESHRE Monograph , 1: 64-72

17. Unexplained infertility
Meta –analysis comparing IUI and TI
in natural cycles showed no difference
in results; therefore, IUI in natural
cycles seems ineffective in case of
unexplained infertility.
Cohen BJ. Gyn. Obst. Invest; 2005,59:3-13
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18. Sexual Dysfunction infertility
• Retrograde ejaculation
• Vaginismus
• Hypospadius
• Impotence
• Infrequent Intercourse during fertile
period.

19. ESHRE Capri Workshop Group
IUI in stimulated cycles may be
considered while waiting for
IVF or when in women with
patent tubes IVF is not
affordable.
ESHRE - Hum Reprod. Update, 2009
Vol,15, No. 3, 265-277
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20. Efficacy of IUI
Intercourse in
natural cycle
IUI in
natural cycle
Intercourse in
stimulated cycle
IUI in
stimulated cycle
Four comparisons to be performed in RCT to (dis)
prove the efficacy of IUI with or without MOH
Cohen BJ and Tournaye H in Macklon NS et al (ed) informa healthcare 2008
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21. Factors affecting IUI success
• Age of the female.
• Natural cycle versus O.I
• Number of IUI treatment cycles.
• Site of insemination
• Exact timing of IUI

22. Complications
• Relatively low success rate / cycle.
• PID 0.01-0.2%.*
• MP
• Prematurity & low birth weight.**
* Dodson and Haney, 1991
*Ombelet et al 1995
**Wong et al 2002, Gaudoin et al 2003, Ombelet et al 2006.