Standard IUI (with mild ovarian stimulation)

Standard IUI is the most common method of assisted reproduction and a first choice method.  According to the latest international data, the number of cycles treated with IUI is double to that with IVF. Interest in IUI was renewed in the last 15 years when sperm preparation techniques for IVF were further developed. IUI is a relatively quick and painless method performed in the doctor’s office without any anaesthesia.  According to the World Health Organization (WHO) and the latest scientific literature, sperm insemination should firstly be performed 4 to 6 times before moving on to IVF. 

Intrauterine insemination is a procedure used for couples with unexplained infertility, ovulation dysfunction, mild or moderate endometriosis, mild male infertility, women with cervical mucus problem, as well as infertility due to immunological factor.  Intrauterine insemination with ovulation induction give better results, often reaching twice the rate of  spontaneous cycles.  Besides, the amount of hormones (gonadotrophins) administered for 4 days is much smaller to that administered for IVF. Finally, the fertilization of the egg will be achieved naturally, in a natural environment.  Insemination is usually performed 24 – 36 hours after the hCG administration (Pregnyl or Profasi). The husband will then produce a sperm specimen, which will be prepared for IUI. The sperm preparation procedure enables the collection of motile spermatozoa and the removal of prostagladins, inflammatory factors  and antigenic proteins found in raw sperm. Another advantage of the sperm preparation is the removal of dead, damaged and abnormal spermatozoa, leukocytes and immature germ cells, bacteria, other cells such as white blood cells and cellular debris. An important factor of the qualitative improvement is the decrease of free oxygen radicals and the prevention of  lymphocin and cytocin production.  Thus, sperm preparation results in its better fertilizing ability in vivo and vitro.

Insemination is performed with a soft catheter, which is passed through the cervix and into the uterus where the 0,5ml of the prepared sperm is deposited.   Insemination is followed by oral administration of progesterone for 14 days for the support of the luteal phase. Pregnancy is confirmed by blood test 14 days after insemination.

IUTPI - Intra Uterine Tubo Peritoneal Insemination (L. Mamas method) 

A new method of insemination with 10ml of inseminate. Observations in our clinical practice showed that, occasionally, the 4 ml of inseminate used for FSP was not sufficient to overcome the tubal ostia, because the intrauterine pressure caused by this volume was not adequate.  Thus, a larger volume of inseminate was gradually used, ultimately reaching 10ml, while simultaneously checking the intrauterine pressure. There was an unexpected increase of pregnancy rates when a larger volume of inseminate was used.  Besides, 10 ml of contrast medium is also used in hysterosalpingography (HSG). In addition, the possible therapeutic effect of HSG has been extensively discussed in various articles over the last decades, since the rate of live births increases after HSG, especially in patients with unexplained infertility, therefore, supporting  the hypothesis that  tubal “plugs” may be involved in proximal tubal blockage. The volume of 10 ml of inseminate was sufficient enough to fill the uterine cavity, pass through the interstitial part of the tubes and the ampulla, finally reaching the peritoneal cavity and the Pouch of Douglas where it would be mixed with the peritoneal and follicular fluids. In this way Intra Utero Tubo Peritoneal Insemination (IUTPI) was achieved.