Intrauterine insemination

Evaluation of female partner

1. Physical parameters

   Anthropometric

   • weight (kg);
   • height (m);
   • body mass index (BMI);
   • normal range : (BMI 19-25);
   • waist girth (cm);
   • hip girth (cm);
   • W:H ratio ;
   • normal value for W:H ratio ‹0.85;
   • normal value for waist girth ‹90cm.
2. Clinical parameters

   Transvaginal sonography

   • Evaluation of uterus , uterine cavity and endometrial response;
   • Measurement of ovarian volume , antral follicle count (AFC) to differentiate PCOS from non-PCOS;
   • HSG: in case of women with infertility period of

   Diagnostic laparoscopy and hysteroscopy:

   • if infertility period is > 5years for evaluation of cervical , uterine , tubal and ovarian factors (irrespective of male factor status);
3. Endocrinological parameters

   Baseline hormones

   • Women (below 35 years ) with menstrual aberrations : serum LH , FSH , TSH , PRL , Estradiol , Testosterone , SHBG , Insulin and GTT ;
   • Women > 35 years with / without menstrual aberrations : serum Antimullerian hormone (AMH) for evaluation of ovarian reserve along with the above mentioned endocrine parameters ;

   D21 Hormone

   • Serum progesterone to rule out ovulatory dysfunction and luteal phase defect.

Evaluation of male factor

1. Clinical parameters

   Medical history

   • Hair distribution score to evaluate secondary sexual characters;
   • Physical examination of tests , epididymis and vas deferens;
   • measurement of volume of tests in case of azoospermia;
2. Laboratory parameters
   • Semen analysis as per WHO criteria;
   • Normospermia;
   • Astheno / necrospermia <25%
3. Grade 3 and 4
   • Teratozoospermia <30% normal morphology ;
   • Oligospermia (Moderate)5 million – 10 million / ml ;
   • Severe oligozoospermia < 5 million / ml;
   • Azoospermia (Obstructive /nonobstructive) (No motile/nonmotile sperm)
4. Investigations
   • No futher investigations unless indicated;
   • Antisperm antibody test;
   • Check for DM/hypertension;
   • Sperm function tests (SFR) Check for varicocele
   • Vasogram , thermogram , Doppler study for varicocele ;
   • Testicular biopsy / FNAT , Endocrine evaluation : FSH , AMH / Inhibin B

Indications of intrauterine insemination

1. Female factor:
   • Anatomic defects of vagina or cervix;
   • Hostile cervical mucus;
   • Sexual dysfunction;
   • Mild to moderate endometriosis;
   • Endocrine anomalies;
   • Chronic anovulatory menstrual cycle;
2. Male factor
   • Anatomic defect of penis e.g. hypospadias ;
   • Sexual / ejaculatory dysfunction ;
   • Retrograde ejaculation ;
   • Semen volume in excess or deficit ;
   • Immunological factors ;
   • Male subfertility : mild oligozoospermia , asthenozoospermia or teratozoospermia;
3. Other factors
   • Idiopatic poor post coital test (PCT);
   • Combined subfertility factors;
   • Unexplained infertility;

IUI with donor sperm

Male factors

• Azoospermia (non-obstructive ) ;
• Severe oligozoospermia ;
• Severe Astheno / necrospermia ;
• Failure in at least six IUI cycles with oligozoospermia ;
• Sterility due to disease or vasectomy , orchidectomy , chemical or radiation exposure ;
• Sexual / ejaculatory dysfunction ;
• Genetic considerations (hemophilia , Huntington’s chorea) ;
• Rh-incompatibility.