Introduction of

Insemination intra uterine

Dicky Moch Rizal
introduction

 Insemination is the deliberate introduction of sperm into a female animal or

plant for the purpose of impregnating or fertilizing the female for sexual
reproduction
 The introduction of semen into the reproductive tract of a female either
through sexual intercourse or through use of an instrument such as a syringe
in the process known as artificial insemination. The American Heritage® Science Dictionary

 Insemination of a woman by sexual intercourse is technically referred to as

"natural insemination"
 Artificial insemination is a medical technique for making a woman
pregnant by injecting previously stored sperm into her womb
1425 1790 1943/1948/1953
•The impotent •John Hunter •Guttmacher/Stoughton/Kohlberg

1784 1899/1922
•Lazzaro spalanzani •Ilya ivanovich
History of insemination

 Unofficial history claims that the first attempts to artificially inseminate a

woman, were done by Henry IV(1425-1474), King of Castile, nicknamed the
Impotent.
 In 1455, he married Princess Juana, sister of Afonso V of Portugal.
 After six years of marriage she gave birth to a daughter, Joanna

 1784, the first artificial insemination in a dog was reported by the

scientist Lazzaro Spallanzani (Italian physiologist, 1729-1799)

 The first documented application of artificial insemination in human was

done in London in the 1790s by John Hunter, which has been called in
medical history the “the founder of scientific surgery”
 Type of insemination

Type of
insemination

Intra Intra
Intra vagina Intra uterine
cervical fallopian
 Fallopian tube sperm perfusion (FSP)
 Fallopian tube sperm perfusion is based on pressure injection of 4 ml of sperm
suspension with an attempt to seal the cervix to prevent semen reflux
 Subgroup analysis revealed that couples suffering from unexplained subfertility
clearly benefit from FSP over IUI
 Sperm Intra-fallopian insemination (SIFI)

 Direct Intra-peritoneal insemination (DIP)

Comparation insemination technique

Intra vagina Intra cervical Intra uterine Intra fallopian

insemination insemination insemination insemination

Easy, Easy, Not too

Difficult
cheap cheap easy

Low Low
Not cheap expensive
successfully successfully
Indication for IUI

 The impossibility of vaginal ejaculation

 psychogenic or organic impotence
 severe hypospadias,
 retrograde ejaculation- cry preservation of sperm in cases of cancer treatment
 .Abnormal male factor- oligospermia- asthenospermia- teratospermia
 Unexplained infertility
 Cervical factor infertility
 Husband is away from wife for long time (work abroad)
 HIV negative women with processed semen of HIV +ve husband
Lab andrology organization

andrologist ObGyn

Supporting Supporting
staff staff
 Steps for IUI

Clinical Laboratory Equippement

• Male patient • setting • Major
• Female patient • minor
Laboratory setting

 Non sterile room

 Room temperature

 Laminar airflow
Equipment
Major equippment Minor equippment

glove

Catheter fo IUI
Microscope binocular
Pippette

Centrifuge : swing out Container

Counting chamber
Incubator Tube

medium
Evidence based Medicine of IUI

 NICE Guidance Feb. 2004

 Couples with mild male factor fertility problems, unexplained fertility problems or
minimal to mild endometriosis should be offered up to six cycles of intra-uterine
insemination because this increases the chance of pregnancy.* Grade A : based
on randomised controlled trials

 NICE Guidance Feb. 2004

 Where intra-uterine insemination is used to manage unexplained fertility
problems, both stimulated and unstimulated intra-uterine insemination are more
effective than no treatment. However, ovarian stimulation should not be offered,
even though it is associated with higher pregnancy rates than unstimulated intra-
uterine insemination, because it carries a risk of multiple pregnancy.
 NICE Guidance Feb. 2004
 Where intra-uterine insemination is used to manage minimal or mild
endometriosis, couples should be informed that ovarian stimulation increases
pregnancy rates compared with no treatment, but that the effectiveness of
unstimulated intra-uterine insemination is uncertain.

 NICE Guidance Feb. 2004

 Where intra-uterine insemination is undertaken, single rather than double
insemination should be offered.Where intra-uterine insemination is used to
manage unexplained fertility problems, fallopian sperm perfusion for insemination
(a large-volume solution, 4 ml) should be offered because it improves pregnancy
rates compared with standard insemination techniques
IUI or IVF ?

 Assisted Reproductive Technology :

 IUI
 IVF : conventiona and ICSI
Misperseption of IUI couple : my experience

 IUI same with IVF

 IUI offer for all the problem
 IUI have high rate of successful
 IUI is the complicated program
 Only need once a time to be pregnant