Intrauterine insemination (IUI) is procedure which involves placing sperm inside a woman's uterus to facilitate fertilization. The ovaries are stimulated with tablets and injections and then monitored for the probable time of ovulation. For more info visit :-//www.newhopeivf.com/intrauterine-insemination-iui.html

2. Intrauterine Insemination (IUI) is the
therapeutic introduction of sperms in
the uterine cavity

3. Function of the Cervix
-Cervical Secretions
-Physiological Filter
-Capacitation & Stores

4. Carrying out the Cervical Function in
the Laboratory
- getting rid of debris, abnormal
sperms, seminal plasma
- picking up good motile sperms
- invitro capacitation

5. Indications
-Cervical Infertility
-Male Infertility
Oligoasthenozoospermia
Azoospermia
Retrograde Ejaculation
Husband living abroad for long stretches of time
-Donor Insemination
-Unexplained Infertility
-Immunological Infertility
-Mild Endometriosis
-Allergy to Seminal Plasma

6. Contraindications
-Unhealthy Tubes
-Acute Genital Infection
-Hyperstimulated Ovaries
-Medical/Psychological/Social

7. Sample Collection
-Masturbation
-Split Ejaculate
-Viscous Sample
-Pooled Ejaculates

8. Rotunda - The Center For Human
Reproduction
-Swim-up using Medicult Flushing Medium
-Density Gradient Separation using Medicult
SupraSperm

9. Buffer Systems & pH
Most Media Utilize The
Physiological Bicarbonate/CO2
buffer system to maintain a
physiological pH of around 7.4 in
the medium.

10. -Preparation Methods Without
Centrifugation Will Be Preferred
-Reactive Oxidative Stress Induced By
Reactive Oxygen Species (ROS) Such
As Hydrogen Peroxide & Super Oxide
Anion
-ROS Affect The Unsaturated Fatty
Acids On The Plasma Membrane Of
The Spermatozoon

11. Techniques of IUI

12. The Volume of the
Inseminate
The Type of Insemination
Type of Catheter used for
Insemination

14. The Type of Insemination
Bolus Technique
Pulsatile Intrauterine Insemination
Slow Release Intrauterine Insemination

15. Why Slow Release?
SRIUI More Physiological
SRIUI may induce local PGs which may
improve sperm transport
BoIUI may have an adverse immunological
impact
BoI may cause polyspermia

16. Type of Catheter used for Insemination
“Atraumatic Embryo Transfer is Essential for
Successful Implantation”
-Leeton J, Trounson A, Jessup D, Wood C. The technique for human
embryo transfer. Fertil Steril 1982;38:156-161.
Wood C, McMaster R, Rennie G, Trounson A, Leeton J. Factors
influencing pregnancy rates following IVF-ET. Fertil Steril 1985;43:245-
247.
-Englert Y, Puissant F, Canus M. Clinical study on embryo transfer after
human IVF. J In Vitro Fertil Embryo Transfer 1986;3:243-246.
-Diedrich K, van der Ven H, Al-Hasani S, Krebs D. Establishment of
pregnancy related to embryo transfer techniques after IVF. Hum Reprod
1989; 4 (Suppl) :111-114.

18. Timing of IUI

19. After insemination,
cryopreserved semen
retains its fertilizing
capacity no longer than
24 hours.
Thus, it is very
important to time your
inseminations well.

20. Two Inseminations before & after ovulation
resulted in a higher PR when compared with a
single insemination.
Silverberg et al. Fertility & Sterility 1992;57:357-361

21. Duration of Treatment

22. OIwith gonadotropins &IUIcompared with IVF&no
therapy: a prospective nonrandomized, cohort study
and meta-analysis
Peterson et al. Fertil-Steril 1994;62(3)535-44.
Cost-benefit analysis comparing hMG &IUI, IVF, &no
therapy in infertility patients may favora course of
fourcycles of hMG and IUIas the first line of therapy.
Using meta-analysis &theoretical assumptions, the PR
forone cycle of hMG &IUIis inferiorto IVF, GIFT, or
ZIFT; two cycles are comparable to IVForZIFT&
inferiorto GIFT; 3 cycles are superiorto IVForZIFT
and comparable to GIFT; and fourcycles are
theoretically superiorto all techniques.

23. Reasons for the high PRs with Superovulation & IUI
-Superovulation corrects subtle ovulatory disorders
- Superovulation increases the number of preovulatory
follicles
-Increase in ovarian size may bring the ovary in close
proximity to the fimbria
- Superovulation may affect tubal vascularity to enhance
ovum pickup mechanisms
-Swim up techniques enhance fertilizing capacity of
sperms
-IUI increases the number of sperms reaching the
Ampullo-Isthmic Junction

24. Predicting & optimizing success in an IUI
program
Fluker SM et al. Hum-Reprod
1994;9(11):2014-2021
IUI is not beneficial to women >40 years
old, and has the best chance of success
within three cycles. Multiple follicle
recruitment using hMG based protocols
and midcycle hCG are necessary to achieve
an acceptable PR.

25. Results

26. June 97-May 98
Indications No. of Pts. No. of Ins. Pregnancies Abortions
Unexplained 48 110 12(25%) 5
Tubal Factor 10 27 2(20%) 1
Anovulation 29 54 4(13.8%) 1
Endometriosis 1 2 - -
Immunological 2 3 - -
Male Factor 36 78 4(11.1%) 2
Multiple Factors 10 41 1(10%) -
Donors 22 119 6(27.3%) -
Total 158 434 29(18.35%) 9

27. Does IUI offer an advantage to cervical cap
insemination in a donor insemination
program?
Williams DB et al. Fertil-Steril
1995;63(2):295-98

28. Value of sperm morphology assessed by
strict criteria for prediction of the outcome
of IUI
Toner JP et al. Andrologia 1995;27(3):143-48

29. A comparision of IUI in superovulated
cycles to intercourse in couples where the
male is receiving steroids for the
treatment of autoimmune infertility
Robinson JN et al. Fertil-Steril
1995;63(6):1260-1266

30. Complications

31. Pregnancy after IUI with Sperm retrieved
from the rectum
Gleicher N et al. Fertil-Steril
1994:67(3);554-555

32. A randomized prospective comparision between IUI
&FSPforthe treatment of Infertility
Karande VC et al. Fertil-Steril 1995;64(3):638-40.
The overall PRs percycle (10.8% versus 10.2%)
were similarforIUIand FSPrespectively. The PRs
were also similarwhen compared forovulation
induction with CC (6.8% versus 9.1%) and
gonadotropins (13.2% versus 11.8%).

33. Fallopian Tube Sperm Perfusion
“Until we have evaluated the procedure of FSP using
the principles of Evidence Based Reproductive
Medicine13
, we should not designate FSP as one of the
milestones of reproductive medicine as has been
attempted by certain groups.”
Desai SK, Allahbadia GN. Middle East Fertility Society
Journal 4(2);173-174:1999.

34. Gamete Intrauterine Transfer
Lens S et al. Baillieres-Clin-Obstet-Gynaecol
1992;6(2):339-49