This document provides information on intrauterine insemination (IUI), including prerequisites, indications, steps, and factors affecting success rates. It summarizes that IUI is a relatively simple and inexpensive fertility treatment that involves placing sperm directly into the uterus. Success rates are affected by factors like total motile sperm count, with counts over 5 million critical. Density gradient preparation is superior to swim-up for abnormal semen. DNA fragmentation levels also impact rates. Guidelines on when to consider IVF instead of further IUI cycles include age over 37, more than 4 failed cycles, severe male factors, and certain ovarian response patterns.

1. PROTOCOLS
Intra Uterine Insemination
(sharing personal experience)
DR . SHARDA JAIN
DR. JYOTI AGARWAL
DR. JYOTI BHASKAR
…..Caring hearts, healing hands

2. Effective , non invasive, relatively simple &
inexpensive method of treatment.
Can be provided easily in simple setups.
IUI

3. PRE REQUISITES FOR IUI
• Atleast one patent functional tube
• Evidence of ovulation
• Adequate sperm count
• Responsive endometrium

4. INDICATIONS OF IUI IN
MALE INFERTILITY
1.Ejaculatory failure
Anatomical (eg.Hypospadias)
Neurological(ex.spinal cord injury )
2. Retrograde ejaculation (eg. Multiple scerosis)
3. Psychological (eg.Impotence)

5. Mild Male Subfertility
*Hysospermia
*Oligospermia
*Asthenospermia
*Teratozoospermia
*Oligostheroteratozoospermia

6. CERVICAL FACTOR
• Cervical mucous
hostility
•Poor cervical
mucus

7. Immunological
• Male antiserum antibodies
• Female antiserum antibodies(cervical,serum)
• Unexplained infertility
• Endometriosis (minimal and mild)
• Ovulatory dysfunction
• Combined infertility factor
• Human immunodeficiency HIV +ve male
• Partner and HIV neg female partner

8. Contraindication
• Duration of infertility >7 yrs.
• Tubal block or other tubal pathology
• Genital tract infections in either partner
• Severely abnormal semen parameters
• Unexplained genital tract bleeding

9. • Older women
• Sever illness in either partner
• Recent chemo/radiotherapy
• Multiple failed IUI cycles
• Co-existing multiple infertility
etiologies
Contraindication

10. STEPS OF IUI
1. selection and counselling about procedure & success rate
2. Protocol ( spontaneous or stimulated cycles)
3.Foliculometry and endometrial thickness
4.Timing of insemination
5.Semen preparation (swim up and density gradient method)
6.Procedure of IUI

11. IUI IS TIMED 36-40 hrs from the
HCG Trigger/24 hrs after LH surge
and will be repeated within 12 hrs if
the oocyte has not released as yet

12. Natural cycle IUI
• Normal female partner
• mild /moderate male factor
• Unexplained infertility
• Monitor with USG (TVS for follicular maturation
• IUI – when mature sized follicle 18-24mm
and >7 - 8mm trilaminar endometrium are
obtained
• Cycle has to be closely monitored with
ultrasound & urinary LH every 4-5 hrs.

13. Criteria for Optimum
Ovarian Stimulation for IUI
• 2-3 follicles with 18-19 mm
• serum E2 levels 150-250 pgm /ml per>15 mm
follicles
• Endometrium >9mm thick and tri-laminar
• IUI between cycle D13 and D16

14. Cancellation
• >6 follicles>15mm irrespective of E2 level
• E2>1500pg ml

15. FEW FACTORS IN MALE
EFFECTING IUI SUCCESS

16. Approximate chance for success getting pregnant with one
month of various treatments
Female age under 35, 2 years of trying to conceive
Type of Treatment Total Motile Sperm Count (in millions)
Less
than 1
1-5 5-10 10-20 > 20
Intercourse 0.2% 1% 2% 2.5% 3%
IUI 0.4% 2% 4% 5% 7%
Clomid plus IUI 0.5% 2.5% 5% 7% 9%
FSH plus IUI 0.5% 2.5% 6% 9% 12%
In Vitro Fertilization - IVF
with ICSI*
60% 60% 60% 60% 60%
*IVF RESULTS DEPEND UPON THE Protocol & IUI lab of the CLINIC

17. THE IMPACT OF THE TOTAL MOTILE
SPERM COUNT
An average total motile sperm count of
10x106 may be a
USEFUL THRESHOLD VALUE
for decisions about treating a couple with IUI
or IVF.
Effect of the total motile sperm count on the efficacy and cost-
effectiveness of intrauterine insemination and in vitro
fertilization. Van Voorhis BJ, et al. Fertil Steril 2001 Apr;75(4):661-8

18. SPERM QUALITY
NECESSARY FOR SUCCESSFUL INTRAUTERINE
INSEMINATION
• Initial sperm motility  30%
• The post wash total motile sperm count 
5 X 106 is critical
• When initial values are lower, IUI has little
chance of success
Comparison of the sperm quality necessary for successful
intrauterine insemination with World Health Organization
threshold values for normal sperm. Dickey RP, et al. Fertil Steril
1999 Apr;71(4):684-9

19. SPERM-PREPARATION TECHNIQUES-
IUI RESULTS
•ABNORMAL SEMEN ANALYSES.
–Density gradient is superior to the swim-up technique in improving
AR, HOS and nuclear maturity rates.
• NORMAL SEMEN ANALYSES.
–When only nuclear maturity rate is taken into account, the swim-
up technique seems to be sufficient for selecting spermatozoa.
Sperm-preparation techniques for men with normal and abnormal semen analysis.- A comparison.
Erel CT, et al. J Reprod Med 2000 Nov;45(11):917-22

20. SPERM DNA FRAGMENTATION
decreases the pregnancy rate in
an Assisted Reproductive
Technique
Mehdi Benchaib et al.Reproduction Vol.18, No.5 pp. 1023±1028, 2003
What is New ?

21. *Patient may have normal
semenology and have
HIGH DFI (DNA fragmentation index)
or
* A very poor count and motility
yet better DFI.
Principle of
DNA Fragmentation

22. Many cases of unexplained infertility who are
unable to conceive by IUI,IVF/ICSI can do
better
* after treatment of causative
factors of Abnormal DFI
or
* by Testicular Extraction of sperm
and ICSI
UTILITY OF
DNA FRAGMENTATION TEST

23. INDICATIONS FOR REFERRAL
to an IVF centre
1. Higher age group>37 yrs.
2. more than 4 cycle failed IUI
3. Severe male sub-fertility
4.No.of mature follicles >6
Number of intermediate follicles >10
5. Moderate to severe endometriosis
6. Need for cryopreservation of semen

24. IMPORTANT TIPS
To DECIDE -WHEN TO MOVE FROM IUI TO IVF?
Each centre should define its policy when to switch for
IVF, which takes into account
•Diagnostic laboratory techniques available,
•Selection of protocols
•Sperm washing techniques – when to use what
•Pregnancy rates achieved by IUI clinic
•Sensibility of the treated population

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