Intrauterine insemination

I.Evaluation of female partner :
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 .

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 <5 years (in absence of severe male factor ) ;

Diagnostic laparoscopy and hysteroscopy : if infertility period is > 5years for evaluation of cervical , uterine , tubal and ovarian factors (irrespective of male factor status) ;

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 .

II.Evaluation of male factor :

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 ;

Laboratory parameters :
-Semen analysis as per WHO criteria ;
-Normospermia ;
-Astheno / necrospermia <25%
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)

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
IUI with the partner sperm
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 .