Selection of patient for IUI and Indications

Intrauterine insemination (IUI) is a fertility treatment designed to improve the chances of conception by introducing sperm directly into the uterus. This procedure is often used in cases of infertility where natural conception is difficult due to various factors.

The IUI process begins with the preparation of sperm, which can be from a partner or a donor. Sperm is collected and then "washed" in a laboratory to concentrate the healthiest sperm and remove impurities such as proteins and dead sperm. This preparation helps to increase the likelihood of sperm reaching and fertilizing an egg.

IUI is generally performed during the woman’s ovulation period to maximize the chance of fertilization. Ovulation can be monitored through various methods such as ovulation predictor kits, blood tests, or ultrasounds. To further improve the chances of success, doctors may use medications to stimulate the ovaries and promote the release of multiple eggs, a process known as ovarian stimulation.

During the IUI procedure itself, a thin catheter is used to insert the prepared sperm directly into the uterine cavity. This is done through the cervix, and the process is relatively quick and minimally invasive. The procedure is usually performed in a doctor’s office, and it generally requires only a short recovery period.

One of the key advantages of IUI is its relatively low invasiveness compared to other assisted reproductive technologies like in vitro fertilization (IVF). It is less complex and more affordable, making it a popular first-line treatment for many couples experiencing fertility issues. IUI is often recommended for conditions such as mild male factor infertility, cervical issues, or unexplained infertility. It can also be used in conjunction with ovulation induction drugs to enhance its effectiveness.

However, IUI is not suitable for everyone. Factors such as severe male infertility, blocked fallopian tubes, or significant uterine abnormalities might necessitate more advanced treatments. Success rates for IUI can vary widely depending on the underlying causes of infertility, age, and overall health, but typically range between 10% to 20% per cycle.

While IUI is generally safe, it can carry some risks, including infection, bleeding, or, in rare cases, an ovarian hyperstimulation syndrome if fertility drugs are used excessively. Additionally, multiple pregnancies, such as twins or triplets, can occur if ovulation-stimulating medications are used.

Overall, IUI represents a significant advancement in reproductive technology, offering many couples a chance to achieve pregnancy with a relatively straightforward and non-invasive procedure. It serves as a valuable option for those seeking to address infertility and achieve their dream of becoming parents.

1. Patient Selection Before IUI FAQs Recent Studies

2. PATIENT SELECTION BEFORE IUI DR. KABERI BANERJEE MEDICAL DIRECTOR ADVANCE FERTILITY AND GYNE CENTRE NEW DELHI MBBS(AIIMS),MD(AIIMS),MRCOG(UK) FELLOW IN REPRODUCTIVE MEDICINE AND IVF, LONDON

3. IUI IUI involves the processing of semen in the laboratory so as to yield pure, activated sperm, devoid of seminal plasma, which are then directly placed into the uterus.

4. Pre IUI Work Up Evaluation and assessment Explain treatment cycle Consenting

5. Indications of IUI Ovulation Disorder Coital dysfunction Male Factor Unexplained Endometriosis

6. Evaluation – Pre pregnancy History and Physical Examination Investigations

7. Evaluation – Pre pregnancy

8. TVS

9. Evaluation before IUI Ovarian function AFCOvar Oo D2 FSH/ estradiol AMH www.ivf-services.com Ovarian function AMH AFC Hormone levels, D2

10. HSG Bilateral Tubal Occlusion Distal/ Proximal

11. Laparoscopy

12. More About IUI Evaluation: Improving Outcome

13. Evaluation: Improving Outcome Hydrosalpinx

14. Evaluation: Improving Outcome Fibroid

15. Evaluation: Improving Outcome Ovarian cyst

16. www.ivf-services.com Evaluation before IUI- Cavity Uterine cavity Mock IUI ? GA Endometrial scratching

17. Hysteroscopy before IUI Suspected Pathology Previous failed attempts Along with Laparoscopy Endometrial scratching and Biopsy

18. Uterine Cavity and Genital TB Evaluating PCR, culture & histopathology in the diagnosis of methods of diagnosis namely, HPE, AFB smear and culture have low sensitivity. PCR was found to be useful in diagnosing early disease as well as confirming diagnosis in clinically suspected cases. False negative PCR was an important limitation in this study. female genital tuberculosis. Thangappah RB , Paramasivan CN , Narayanan S . Source Indian J Med Res. 2011 Jul;134(1):40-6. Department of Obstetrics & Gynaecology , Women & Children Hospital, Chennai, India.

19. Genital tuberculosis among infertile women and fertility outcome after antitubercular therapy. CONCLUSION: No single test can detect all instances of GTB. A combination of tests is needed to increase the detection rate. Treatment given solely on the basis of a positive PCR result can result in conception. Kulshrestha V, Kriplani A, Agarwal N, Singh UB, Rana T. SourceInt J Gynaecol Obstet. 2011 Jun;113(3):229-34. Epub 2011 Mar 31. Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India. Uterine Cavity and Genital TB

20. Sperm Parameters and IUI

21. WHO references

22. Method Swim up method Normozoospermia Density gradient centrifugation Severe oligozoospermia , teratozoospermia or asthenozoospermia

23. Best Results TMSC 5 mill 5-20 mill > 20 mill 24 hour incubation sperm motility

24. Pre IUI Work Up Evaluation and assessment Explain treatment cycle Consenting

25. Counselling in IUI Physiology Procedure details No of visits SUCCESS RATES ( per cycle and cumulative) Consents Costs

26. AGE

27. DURATION

28. PREVIOUS TREATMENT

29. Good prognosis patients for IUI? Young Less duration of infertility Good sperms Tubes patent Ovulatory dysfunction Fewer treatment attempts No other associated pathology

30. Old Long duration of infertility Tubes blocked ( uni /bi) Very poor sperm Long treatment history Presence of other pathologies