1. Dr Anand K. Shinde (M.D)
Fellow C.S.E.P.I. Centre for Assisted Reproduction
Deenanath Mangeshkar Hospital, Pune – 4
Tel: 56023395, M: 98220-12166
 Intera Uterine Insemination
 Some Practical Considerations
Dr Anand K Shinde
Pune

2. IUI
Why does it work?
2. It works because Cervix is by passed
3. Better quality & more number of sperms
enter uterine cavity
4. It is deliberately ‘timed’ near ovulation,
ensuring good chance of fertilisation
5. ‘Semen-washing’ process removes
detrimental elements like seminal plasma,
WBCS + dead sperms.

3. Why C.O.H. is coupled with IUI?
• Timing of HCG injection predicts ovulation
better, so as to schedule IUI near ovulation
time.
• Controlled Ovarian Hyperstimulation
(C.O.H.) offers more over for fertilization &
implantation, hence increases success.
• C.O.H. corrects subtle endocrinopathies
which block ovulation, implantation

4. What Success rate for IUI can be
quoted?
1. It depends on case selection indication, wife’s age,
motile sperm count, media & method used & ease of
catheter passage at insemination. EVERYTHING
MATTERS.
2. Success rate does not exceed natural fecundity rate.
Good units quote a success rate from 10% to 20%
per cycle.
3. At this rate it may touch 60% at end of 5-6 months &
does not increase thereafter. So if 6 good cycles &
good inseminations have not worked then review the
diagnosis 7 indication.
4. Success in ‘natural’ cycle can be as low as 5%
success with Clomiphene/Letrozole climbs upto
7-10%. Adding HMG/FSH along with Clomiphene can
take success rate upto 20% per cycle. Combination
of oral medication with HMG does not lessen
success rate but cuts down total cost of HMG/FSH.

5. What are contraindications to IUI
• Blocked tubes, major tube pathology
• Genital tract infection in either wife or husband
• Severe abnormality in semen parameters (low
count < 5 million in pre-wash sample,
asthenospermia, severe teratospermia)
• Genetic reason for above poor semen parameters
• Wife’s age advanced
• Multiple aetiologies/co-existing factors for
infertility
• Multiple, previous failures of IUI.

6. When Contraindications are ruled out,
what could be indications for IUI?
1. Male factors amenable to IUI
2. Female factors amenable to IUI
3. Indications for Donor Insemination

7. ‘Male Factors’ helped by IUI
A) Using ‘Fresh’ husband semen
• Retrograde Ejaculation
• Impotence or Ejaculatory Dysfunction
• Hypospadias
• Hypospermia (Low Volume)
• Non Liquefying/highly viscous semen
• ‘Subnormal’ semen parameters
• Seminal Antisperm Antibody
• Unexplained Infertility
B) Using ‘Frozen’ husband semen
• Absent Husband (N.R.I.)
• Anti cancer treatment in husband
• Vasectomy

8. ‘Female Factors’ helped by IUI
• Vaginismus
• Cervical Hostility
• Ovulatory Dysfunction
• Mild Endometriosis
• Allergy to seminal plasma
• Unexplained infertility

9. Indications for Donor Semen IUI
• Azoospermia with testicular failure
• Severely abnormal semen parameters Use
Discretion)
• Hereditary disease in man
• Severe untreatable Rh isoimmunisation in wife
• Repeated failures with IVF/ICSI
• Single women, lesbian couples (Use Discretion)

10. What are possible complications
of IUI ?
• Uppermost in mind but very less likely problem is
infection. It may occur in 0.01% to 0.2% cases.
• Allergy to some component in the media used
Albumin, antibiotic etc) rarely occurs.
• C.O.H. increases chance of multiple gestations
• C.O.H. even properly conducted has 1% chance of
Ovarian Hyperstimulation Syndrome developing
(OHSS)
• Miscarriage rate of 20-30% is slightly higher but not
directly related to IUI per se but the couples which
get chosen for IUI
• 3 to 5% ectopic pregnancy rate must ensure
alertness on part of clinicians.

11. Should we do multiple IUI in one
cycle?
• Ensuring presence of adequate number of motile
sperms in the fallopian tube to greet the freshly
ovulated oocyte is the aim of a ‘well timed’ IUI
• This is possible when ovulation is triggered by
injection. HCG & IUI is timed at 36 hours after it. In
this method single IUI in one cycle is sufficient
• Evidence shows no increase in success rate by
doing ‘pre-ovulatory’ & ‘post-ovulatory’ IUI.
• The problem & discussions arise because we use
ultrasound to predict or demonstrate ovulation &
then schedule the IUI. This has its own pitfalls.

12. Is post IUI antibiotic or progestational
support necessary?
• The couple certainly needs to be free of infection
‘prior’ to IUI
• If semen shows pyospermia (W.B.C.s > 1 million/ml)
or if P.C.T. or speculum inspection of cervix
suggests infection it is better to clear it before IUI.
• IUI per se is at low risk for infection.
• Luteal phase support is individualized, it works
where it is indicated only.

13. What other surveillance in IUI
case is needed ?
• In COH cycle look out for signs/symptoms of
OHSS & the patient should report early
• 2-5% Ectopic pregnancy :Be Alert
• Multiple Gestations.

14. What are difficult situations in IUI
couples ?
• Husband unable to provide semen (tension, non
erection etc) on day of ovulation.
• Semen parameters very different from previous
reports (should not happen but episodes of fever
etc can change count, motility. Poor ejaculation
may be result of tension on day of IUI)
• Cervix not negotiable, resulting in struggle &
bleeding, which simply harms any chance of
success. (Be prepared beforehand – proper OPD
check up, SOS cervical dilation in previous visit,
proper measuring of utero cervical length & utero
cervical angulation at T.V.S.
• Unco-operative, grossly obese patient. Prior
counseling helps here.