Timing is more important for IUI than it is for intercourse. Here is the Dr. Laxmi Shrikhande explain on optimizing iui outcome

1. Dr. Laxmi Shrikhande MD; FICOG; FICMU;FICMCH
• Medical Director-Shrikhande Fertility Clinic, Nagpur
• Chairperson Designate Indian College of OB/GY ICOG
• National Corresponding Editor-The Journal of Obstetrics &Gynecology of India
• Senior Vice President FOGSI 2012
• Patron & President -Vidarbha Chapter ISOPARB
• Received Nagpur Ratan Award at the hands of Union Minister Shri Nitinji Gadkari
• Received Bharat excellence Award for women’s health
• Received Mehroo Dara Hansotia award for Best Committee of FOGSI
• National Governing Council member ICOG 2012-2017
• National Governing Council Member ISAR 2014-2019
• National Governing Council Member IAGE for 3 terms
• Chairperson-HIV/AIDS Committee, FOGSI (2007-09)
• President Nagpur OB/GY Society 2005-06
• Immediate Past President Menopause Society, Nagpur
• Associate member of RCOG & ESHRE
• Member of European Society of Human Reproduction
• Visited 96 FOGSI Societies as invited faculty
• Delivered 11 orations and 450 guest lectures
• Publications-Twenty National & eleven International
• Presented Papers in FIGO, AICOG, SAFOG, AICC-RCOG conferences
• Conducted adolescent health programme for more than 15,000 adolescent girls
• Conducted health awareness programme for more than 10,000 women

2. Optimizing IUI outcome
DR LAXMI SHRIKHANDE
NAGPUR

3. IUI is the 1st Line of treatment in sub fertility
 simple,
 effective
 inexpensive
 Can be performed by all the gynecs
 Even in remote areas
Why talk so much about IUI ?

4. Approx. chance of getting pregnant with 1 month of Rx
Female age <35, 2yrs of trying to conceive
Rx type Total Motile Sperm Count (in Millions)
< 1 1-5 5 – 10 10 – 20 > 20
Intercourse
(on own)
0.2% 1% 2% 2.5% 3%
IUI 0.4% 2% 4% 5% 7%
Stimulated IUI 0.5% 2.5% 7% 8% 10%
IUI – Success rates

5. Factors affecting IUI outcome
Semen parameters
Age of the women
Ovarian reserve
Etiology of Subfertility
Super ovulation vs natural
IUI – timing & technique
- no of inseminations
- no of cycles
- luteal support

6. Does all IUI cycles needs to be stimulated one ?
The PR was lower in the Natural Cycle than in the COH group (11.35%
versus 19.61%,
No difference in PR rate among the subgroups of CC , HMG and CC +
HMG (18.00%, 25.00% and 19.35%,
CONCLUSION:
The ovulation induction cycle could achieve a higher PR than the
natural cycle in IUI, whether with CC, HMG or CC + HMG, particularly
for the infertile patients under 35 years.
Chen L, Liu Q. Zhonghua Nan Ke Xue. 2009 .

7. Natural cycle IUI
Donor Inseminations
Mild/Moderate male factor infertility
Cervical factor infertility
Especially if female age is < 30

8.  Timing is more important for IUI than it is for intercourse.
 The reason is that, during intercourse, sperm travels
through the cervical canal.
 There are glands and mucous in the cervix that sustains the
sperm and acts as a reservoir that releases sperm into the
uterus slowly over several days.
Timing

9.  During an intrauterine insemination, the sperm are
released into the uterus.
 The sperm do not remain viable for as long a period of
time.
 Consequently, the sperm must be inseminated close to
the time of ovulation.
Timing

10. When IUI should be done ??
after 36 hours of HCG
or
after documented ovulation
or
along with HCG?

11. Single vs double intrauterine insemination ;
Double versus single intrauterine insemination for
unexplained infertility: a meta-analysis of randomized trials.
Despite the 36th hour being the preferred timing for IUI,
there was no difference regarding pregnancy rates between
single 24th hour and double 12th- and 36th-hour
inseminations..
Rahman SM Fertil Steril. 2010 Dec
Tongue E, Fertil Steril. 2010 Sep
Bagis T et al., Hum Reprod. 2010 Jul
Polyzos NP Fertil Steril. 2010 Sept
Ghanem Mlet al,Hum Reprod. 2011 Mar.

12. Abstinence before IUI?
It is not necessary to abstain from intercourse before doing an IUI.
Sperm counts vary in all men.
The frequency of ejaculation does not have any consistent effect on sperm
numbers.
sometimes there will be more sperm on a second or third ejaculate and
sometimes there will be less sperm.
recommendation is to have intercourse on the day that an ovulation kit turns
positive or on the day that an hCG trigger injection is given.
The IUI is then timed as indicated above.

13. Consent
Must-ICMR website
Verify yourself
Adhar card of both, marriage certificate

14. IUI-D
No fresh sample
Reputed Semen banks
Not from known donor
No mixing of donor samples
Preserve records

15. Tips & Tricks for doing IUI ?
Cervical mucus aspiration
Full bladder
USG guidance
Passive straitening of cx
Type of catheter
Volume of inseminate
Speed of Inseminate

16. What can be done to improve endometrial thickness ??
CC - exerts anti estrogenic effects on the endometrium
Rx
Delay ovulation trigger till endometrium >7mm
adjuvants-ASA/silnafil/estrogen?
Hysteroscopy

17. Optimizing IUI Outcome
When to cancel the cycle ?
How to prevent OHSS and Multiple pregnancy ?

18. Take Home Message
Proper Patient selection
Appropriate stimulation protocol
Good quality lab work
Meticulous Procedure
Luteal Phase support
IS THE KEY TO INCREASE IUI SUCCESS RATE

19. “No matter how good you get
you can always get better
and that's the exciting part”.
~ Tiger Woods ~

20. Questions

22. The Art of Living
Anything that
helps you to
become
unconditionally
happy and loving
is what is called
spirituality.
H. H. Sri Sri Ravishakar