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Unfortunately most people doing IUI do not follow a very precise technique and the procedure is unnecessarily blamed for the failure.
Ovaries can be stimulated to produce ova by tablets-clomiphene citrate-CC, or by injections –gonadotrophins. The advantage of IUI is that, a bulk of the best quality sperms are placed in the uterus- closer to the ovum and vaginal acidity is also bypassed, so fertilization is facilitated.
Stimulation is continued till these parameters are achieved and then hCG 10,000 or rhCG 250iu is given to rupture the follicle. The time interval for the processed sample, from the CO2 incubator to the patient’s uterus should be the shortest. Any compromise at any of the previous described steps will definitely compromise with the results. A sperm count of 4 million after semen processing is considered as optimum but best results are achieved when the count after processing is 8-10 million.

IUI can give best results only when better quality follicles are produced by gonadotrophin injections, proper ultrasound monitoring is done, proper semen processing is done IUI is done at a correct time, in a correct way and proper support-medicines are given after IUI. When follicle grows to the required size, Doppler is done to assess its functional capacity.
In patients with polycystic ovarian syndrome(PCOS), there are multiple follicles and if hCG is given, these patients are likely to develop a serious complication called ovarian hyperstimulation syndrome. Therefore it is always preferable that the semen processing lab is in the same premises as the infertility centre or where IUI is done.
When endometrium grows to the desired thickness, its Doppler is also done to assess its implantation capability. Ovarian stimulation can also be done by a combination of CC and gonadotrophins, but results are not as good as that with gonadotrophins alone, though the cost is definitely reduced. There are 3-4 different gonadotrophins available, but rFSH has been proved to be the best world wide.

For a good semen preparation, the laboratory should be equipped with microscope, CO2 incubator, simple incubator and a high quality centrifuge machine. Moreover each semen sample is different and requires a little modification of technique and so the person doing the semen processing should be specially trained for it and should be a decidated and sincere worker. A well prepared sample should have no debris and 95% of sperms in the sample should show good motility.

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