• Husband
• Anonymous donor

• Ovulatory Dysfunction(PCOS)
• Unexplained Infertility
• Mild to Moderate Male Factor Infertility
• Mild to Moderate Endometriosis
• Cervical Factor
• Ejaculatory Dysfunction
• Vaginismis

• A semen specimen from the male is processed (or “washed”) in the laboratory
• The processed semen sample is drawn into a sterile catheter
• The catheter is inserted through the cervix into the uterus
• The processed semen is injected into the uterine cavity
• This is a simple procedure and should be similar to a Pap smear for the woman

• Blockage of Both Fallopian Tubes
• Severe Male Factor Infertility
• Severe Endometriosis
• Previously Failed Six IUI Cycles

For these conditions, Invitro Fertilization (IVF)/ICSI is the treatment of choice.

Normally in a natural intercourse, semen is deposited in to the vagina, and this semen sample is a mixture of healthy, as well as abnormal sperms. From here(vagina), healthy sperms travel through the cervix to reach the uterus, and then to the fallopian tubes for fertilization with the egg.

The rationale of the IUI treatment is to deposit highly concentrated morphological normal motile sperms directly in to the uterine cavity ( after semen processing, which removes the abnormal sperms and seminal plasma ), bypassing the cervix, around the exact time of ovulation, thereby optimizing fertilization process.

• Natural IUI
• Clomid IUI
• Injectable IUI

• Age of the Female Partner
• Underlying Clinical Problem
• PCOS
• Unexplained Infertility
• Endometriosis
• Severity of Male Factor Infertility
• Tubal Pathology
• Expertise of Doctor
• Method of Semen Processing

• Several studies have addressed this question
• Some studies show no improvement in success with 2 inseminations done on sequential days compared to 1 well-timed IUI
• Others show higher success if 2 inseminations are done on back to back days
• One explanation for the different findings is that if single inseminations are not ideally timed for ovulation, success rates could improve with a double insemination protocol. Then, at least one of the inseminations might be properly timed.
• Most fertility specialists believe that 1 well-timed IUI is sufficient

• It is well known that chances for success with IUI in women over age 40 are much lower. The results of several studies have been consistent in showing this.
• Many couples with a female partner over 40 will move fairly quickly to IVF treatment
• Two issues pushing for this are the low success rates with IUIs over 40 and the understanding that there is an ever-shortening fertility window.
• Most studies have shown a success rate (delivery of a baby) at age 41 of about:
  • 1-2% per month with Clomid + IUI
  • 2-4% per month with injectables + IUI
  • IVF success rates are much higher – about 20% at age 41 in our IVF program

• Women with Polycystic Ovarian Syndrome (PCOS) have ovulation issues
• The first-line treatment is usually inducing ovulation with medications
• If the woman responds properly to the ovulation inducing drugs, success rates with timed intercourse are pretty good
• However, IUIs are also used in these couples with an even higher success rate
  • Clomid or Femara plus IUI with PCOS 15-20% success per month (for 3 months)
  • Injectables plus IUI with PCOS 20-25% success per month (for 3 months)
  • However, multiple pregnancy risks are high with injectables for PCOS

After the early 30’s, advancing female age has a significant negative impact on fertility – regardless of the method used to get pregnant.

One published study of over 4000 Clomid plus IUI cycles showed IUI success rates as shown in the table. (Reference: Serena Dovey, et al, Clomiphene citrate and intrauterine insemination: analysis of more than 4100 cycles, Fertility and Sterility; December, 2008).

Age and Success Rates from Clomid-IUI
Female Age	Percent Pregnant Per Cycle Completed
Under 35	11%
35-37	9%
38-40	7%
41-42	4%
Over 42	1%

Unexplained infertility is a very common situation, we say that a couple has unexplained infertility if they have normal sperm, open fallopian tubes, no known endometriosis and no ovulation problem.

Success rates with IUI in couples with unexplained infertility has been investigated in many studies. In couples with a young female partner (under age 35) studies have shown:

• Clomid plus IUI has about an 8% per month chance for successful pregnancy
• Injectable FSH products (“injectables”) plus IUI give about 12% success per month
• These statistics hold for about 3 months and after that success rates are much lower
• Chances for success with IVF are very good in young women regardless of whether IUIs have worked or not

Intrauterine insemination statistics with endometriosis in the female are dependent on the severity of the endometriosis.

As the severity of the endometriosis increases, the success chances with insemination drop significantly. For severe endometriosis, IUI success rates are very low.

Success rates with IUI for endometriosis have been variable in studies, showing:

• A pregnancy rate of 6.5% for women with endometriosis vs 15.3% per cycle for unexplained infertilityReference: Nuojua-Huttunen et al, Intrauterine insemination treatment in subfertility: an analysis of factors affecting outcome. Human Reproduction 1999.
• A pregnancy rate of 5.6% for women with advanced endometriosis vs 22.7% per cycle for mild endometriosis vs 25.7% for no endometriosisReference: Prado-Perez et al, The impact of endometriosis on the rate of pregnancy of patients submitted to intrauterine insemination. Fertility and Sterility, 2002.
• Pregnancy chances with insemination for natural cycle IUIs (no drugs) with endometriosis are about 2% per cycle vs 11% with injectables plus IUI for endometriosis

What is the difference in pregnancy rates for couples with fertility problems between trying with regular intercourse versus IUIs?

• A couple that has been trying for a year and a half and does not have tubal problems, sperm problems or endometriosis has about a 2% chance per month (over the next year) of getting pregnant from regular intercourse
• If a similar couple does Clomid with IUIs, the expected success rate is 10% per month for up to 3 months

We are not sure why IUIs increase chances for pregnancy that much. Certainly the sperm is boosted higher in the woman’s body (closer to the eggs) and timing is maximized.

Coming Soon…

Complication are very rare, though occassional chances of Uterine Infection, Multi Fetal Pregnancy, Topic Pregnancy, Ovarian Hyperstimulation Syndrome .

• How long does it take for the procedure ?
  The semen processing takes approx 45 mins to 1 hour, after submission of the semen sample, which is most boften by masturbation. It is preferred that the sample is procured within the hospital premises. After the sample is processed its takes 5-10 min for insemination.
• How much rest is required after the procedure ?
  We commonly advice a rest of 10-15 min post insemination in the hospital.
• Can I carry my normal activities after the procedure ?
  Ofcourse, there is no restrictions at all after the procedure.
• Is it done under anaesthesia ?
  Majority of the time, it is without anaesthesia, but however in selected group of patients, the provision of anaesthesia can be made available.
• Is it painful ?
  In most of the cases, it’s the experience like a pap test.
• Is it done ultrasound guided ?
  Usually not, but in selected cases, like H/O difficult transfers, patient request.
• Do I need to take leave from work after the procedure ?
  You may commence work the very same day.
• Do you check rupture before iui ?I follow the dynamics of body physiology, that once a triggering injection for rupture is given, in majority of the cases the follicles would rupture betw 36- 48 hours. The inseminated semen sample, would have viable sperms for atleast minimum 48-72 hours and the viability of egg is 24 hrs.Since follicle rupture is a dynamic procedure, the exact time of rupture is very difficult to predict, however I take the help of the LH surge kit, where in if there is a surge on the day of ing HCG, the iui is performed in the next 24 hours.
• Can we get semen sample from home ?
  Can be brought from home, provided you reach the hospital within 30-45 mins of ejaculation. In such conditions, the doctor should be informed, so that a sterile container can be made available prior. The container containing the sample should be kept at body temperature.
• Are my husbands sperms only used ?
  There is no room for error as all the samples are doubled witnessed.