Post on 21-Aug-2015
IntraUterine InseminationIntraUterine Insemination
04/18/23 1
04/18/23 2
•Easy to perform
•Training is easy
•Less invasive
•Risks are minimal
•Quality control possible
•Costs are minimal
Advantage
Items Addressed
04/18/23 3
• What is IUI.
•Indications.
•Effectiveness.
•Cost Effectiveness.
• Factors affecting success rate.
•Advantages and complications.
The rationale is bypassing the cervical-mucus barrier and increasing
the number of motile spermatozoa with a high proportion of normal forms at the site of fertilization.
04/18/23 4
Semen Preparation Techniques
04/18/23 5
-Swim up.
-Albumin
-Percoll
-Minipercoll
04/18/23 6
The washing procedures are necessary to remove prostaglandins, infectious agents, antigenic proteins, non-motile spermatozoa, leucocytes and immature germ cells.
Timing of IUI• Basal Body Temperature
• LH Surge ( urine/serum)
• US
Sites of insemination
• Intrauterine (IUI)
• Intracervical (ICI)
Indications • Male factor subfertility• Unexplained infertility• Endometriosis.• Combined ovulatory and ♂ factor
infertility.• Cervical and immunological infertility• Sexual dysfunction infertility.
04/18/23 10
In long standing infertility caused by reduced sperm quality
expectant treatment seems to be disappointing with a spontaneous
conception rate of only 2% per cycle.
Collins J A et al. Fertil Steril; 1995, 64:22-28
Male Factor Subfertility
5th centile 95%CI
Volume 1,5ml (1.4-1.7
P H 7.2
Motility 40% (38-42)
Progressive Non progressive Immotile
32% (31-34)
Vitality (intact membrane)
58% (55-63)
Count 15X106 12-16X10 6
Normal forms 4% (3-4)
04/18/23 11
The lower reference limit for semen analysis
WHO Lab Manual of Human Semen 2010
04/18/23 12
-Oligozoospermia (O)
-Asthenozoospermia (A)
-Tratozoospermia (T)
Male factor Infertility (OAT)
Male subfertility
04/18/23 13
In male subfertility IUI with or without COH a pregnancy rate of 10-18% per cycle has
been reported.
-Stone BA et al 1999. Am. J Obstet Gynecol, 180:1522-1534
- Ombelet W et al 1995,Hum. Reprod. 10 (Suppl. 1):90-120
- Ombelet W et al 1997. Hum. Reprod. 12:1458-1463
Male subfertility
04/18/23 14
A Cochrane review showed that IUI is superior to TI,
both in natural and in cycles with CoH.
Cohlen BJ et al 2000. (Cochrane Review)
Cochrane library, issue 4, update software, Oxford.
04/18/23 15
(cumulative ongoing PR of 21.9% after three IUI cycles).
-Centole GM 1997. J. Androl; 18:448-453
Infertility work -up
No tubal factor
HSG, Laparoscopy, HSCS..
Washing procedure
IMC> 1 millionIMC< 1 million
IMC< 1 million
Morphology <5%
IVF
< 30 % or no fertilization
ICSI
IUI 4x
Proposed algorithm of male subfertility treatment at the Genk Institute for fertility Technology (ICM, insemination motile count of the number of motile spermatozoa after washing procedure; HSG, hysterisalpingography; HSCS, hysatero-salpingo-contrast-sonography)
Ombelet W et al 2008). ESHRE Monograph , 1: 64-72
04/18/23 17
Meta –analysis comparing IUI and TI in natural cycles showed no difference
in results; therefore, IUI in natural cycles seems ineffective in case of
unexplained infertility.
Unexplained infertility
Cohen BJ. Gyn. Obst. Invest; 2005,59:3-13
Sexual Dysfunction infertility
• Retrograde ejaculation• Vaginismus• Hypospadius• Impotence• Infrequent Intercourse during fertile
period.
04/18/23 19
ESHRE Capri Workshop Group
IUI in stimulated cycles may be considered while waiting for IVF or when in women with
patent tubes IVF is not affordable.
ESHRE - Hum Reprod. Update, 2009
Vol,15, No. 3, 265-277
Efficacy of IUI
04/18/23 20
Intercourse in natural cycle
IUI in
natural cycle
Intercourse in stimulated cycle
IUI in stimulated cycle
Four comparisons to be performed in RCT to (dis) prove the efficacy of IUI with or without MOH
Cohen BJ and Tournaye H in Macklon NS et al (ed) informa healthcare 2008
Factors affecting IUI success
• Age of the female.• Natural cycle versus O.I• Number of IUI treatment cycles. • Site of insemination• Exact timing of IUI
Complications • Relatively low success rate / cycle.
• PID 0.01-0.2%.*
• MP
• Prematurity & low birth weight.**
* Dodson and Haney, 1991*Ombelet et al 1995**Wong et al 2002, Gaudoin et al 2003, Ombelet et al 2006.