Dr Aniruddha Malpani, MD

Malpani Infertility Clinic

www.drmalpani.com
 IUI – the basics
Eggs plus sperm = baby !
1. Superovulate
2. Time ovulation accurately
3. Process sperm ( to improve their
quality)
4. Insert sperm into the uterus with a
catheter
The key to success ?
What catheter you use ?
How many times you do the insemination ?
( double versus single)
What sperm preparation technique you use ?
 wash or swim up or gradient
How you superovulate ?
Letrozole or clomid or HMG
Superovulate ( grow more eggs)
Clomid ? Letrozole ?
HMG ?
FSH ?
Recombinant ?
How many follicles ?
Time ovulation
Monitor with ultrasound scans
Follicle size and endometrial thickness and
texture
Optimal follicle size ?
Monitor with urinary LH strips
HCG injection for inducing ovulation
? GnRH analog for inducing ovulation
Timing of IUI
Before ovulation ?
After ovulation ?
How many times ?
Single ?
Double
Intercourse ?
How to process the sperm ?
Swim up ?
Wash ?
Culture medium ?
With HEPES ?
Add Pentoxyfylline to improve sperm motility ?
Gradient density centrifugation ?
Motile sperm count ?
Volume ?
Technique of IUI
Which catheter ?
Soft ?
Rigid ?
Does the brand matter ?
Indian ? Foreign ?
Location of catheter tip ?
Fundal ?
Bed rest after IUI ?
The key to success ?
What catheter you use ?
How many times you do the insemination ?
( double versus single)
What sperm preparation technique you use ?
 wash or swim up or gradient
How you superovulate ?
Letrozole or clomid or HMG
The secret to IUI success ?
Patient selection !
Major problem with IUI
Easy to do
Inexpensive
Everyone wants to do it
Done for all the wrong reasons
Unrealistic expectations
• Patients
– Eggs plus sperm = baby
– Expect instant success
– Get upset and frustrated
– Lose confidence in doctors
Unrealistic expectations
• Doctors
– Do not understand limitations of IUI
– Overpromise – claim success rates of
20%
– Too many attempts
Dangers
Multiple pregnancy
Infection ( poorly prepared sperm)
OHSS
Best results when
Young patient
Good sperm
Normal tubes
Normal uterus
Unexplained infertility
Poor results
Poor sperm count
Older women
Poor ovarian reserve
Damaged tubes
Many previous failed IUI cycles
Real life problems
Patients run around from clinic to scan
center to lab
Poor documentation
Sperm sample – not seen by doctor or
shown to patient
Long time delays after sperm is prepared
Not on a Sunday !
Take home messages
Select patients carefully
Keep records and analyse them !
Do everything under one roof
Do not do more than 4 IUIs
Know when to refer for IVF