This document outlines 10 secrets to success for intrauterine insemination (IUI). It discusses factors such as choosing the right patients based on their infertility diagnosis and prognosis, understanding the patient's ovarian and endometrial response based on age and biomarkers, using an individualized ovarian stimulation protocol, modifying treatment based on endometrial thickness, proper follicle monitoring and HCG trigger timing, optimizing IUI timing and semen preparation, ensuring proper IUI technique, providing luteal phase support with vaginal progesterone, knowing when to stop IUI treatment, and maintaining a cohesive team with thorough documentation and analysis of results. The overall message is that success in IUI lies in attention to many details of patient selection, treatment planning

1. 10 secrets of success of IUI
Dr. Sharda Jain
Programme Director

2. 1st
Secret
Right choice based on facts
(Actiology)

3. Good Result : - Unexplained I
: - Cervical Factor I
: - Anovulatory I
: - Donar IUI
Poor Results :- severe male infertility
tubal factor/
pelvic adhesions
severe endometriosis

4. 2nd secret
• Age – women & men
• Ovarian response (Poor /High/ Normal)
• Endometrial Response
• AMH
Understand The Case (H & W)

5. Good Responders :- young
:- Good Crop of
Preovulatory follicles
:- Good ET (> 7 mm)
:- Good PMS count
Poor Responders
:- Older self / partner,
:- ↑ duration infertility (> 5 yrs)
:- Poor OR
:- Poor ET
:- Poor Sperm Quality

6. Male age - < 35 yrs
> 45 yrs
>10 million prewash count
5-10 million Post Wash Count
Normal morphology – 14% (Krugers)
DNA fragmentation - 30 %
Sperm survival (24 hours) - ↑ 80%
Male

7. 3rd secret
• Typical PR 4 / 8 / 12 / 20
• G T
• Antagonist in IUI protocol
Individualised Ovarian Stimulation Protocol

8. 4th secret
• CC – neg. effect on ET – EV ?
• Delay trigger
• GT
• Scratching of Endometrium
• ↑ Endo Vascularity
(Aspirin/ Viagra / Sidnafil)
Poor Endometrial Thickness

9. Modify Dose / ET / Follicle size / HCG Trigger
- GT
- EV
5th secret
Follicle Monitoring
Do it your self

10. Trigger when
GT – 17-18 mm
CC -24 -25 mm
Doppler – Perifollicular perfusion 50 – 70 %
RI < 5
PSV > 11
S/C HCG – (BMI)
Agonist trigger - OHSS
6th secret
Do Right Thing at Right Time

11. Timing of IUI – 38 hours
Single – No Male Factor
Double IUI – Male factor, PSV > 20
1st
16 - 18 hrs
2nd
36 – 38 hrs
+ LH surge - Give HCG trigger immediately
- IUI 24 hrs

12. 7th secret
• Labeling
• Abstinance (<3 V/S > 10 days)
• Semen collection
• Semen preparation
One size does not fit all
• High quality Consumables & media
Preparation in doctor’s office must
Lab secret

13. 8th secret
• Full Bladder
• Cx mucus aspiration
• Targets time - 90 minutes
• Load – when ready
• No free space
• Rest 10 mints
• Emergency trey
Easy IUI
Success lies in looking into details of techniques

14. 9th secret
• Progesterone
• Vaginal progesterone (↑ PR) is the BEST
Luteal support

15. 10th secret
Counseling / Knowing when to stop
3 cycles of IUI = 1 IVF

16. Final secret
All that we are
• Integrity of Team
• Right documentation
• Analysis of Result what works

17. Thanks