What is Difficult IUI ?

What is Difficult IUI ?

Sometimes there may be problem in visualizing the cervix and doing IUI. In these cases, one should use a tenaculum (long vaginal instrument) and give traction to manipulate the Utero-Cervix angle and also to stabilize the cervix. Maklers or metal catheter (standard) also help in these cases.

VIDEO : Endometrial contractions seen in USG. These may be seen in cases of difficult IUI and may hamper the result.

Various positions of the uterus during Difficult IUI:

  • Empty Bladder and Acutely Anteverted Uterus

acutrely_anteverted_uterus

In these cases it is better to have a Full Bladder and or use Allis (instrument) Traction in the opposite direction as shown in the figure below.

 acutrely_anteverted_uterus2

  1. Full Bladder and Acutely Retroverted Uterus.

 acutrely_retroverted_uterus

In these cases, patient should empty her bladder and traction should be applied using Allis forceps or tenaculum in the opposite direction as shown in the figure below.

 acutrely_retroverted_uterus2

Ankoor clinic recommendations:

In cases of Difficult IUI, one must consider cervical dilatation with smallest dilator (helps to identify the direction and also to negotiate the stenosis). Also it is very important to make a note on the paper and consider for Cervical dilatation on the 1st or 2nd day of next menses.

 

Is Ultrasound-guided IUI better ?

Studies have shown that Ultrasound-guided IUI does not produce better results than blind insemination, because the pregnancy rate per cycle is similar. (Reference: Hum Reprod. 2009 May;24(5):1080-4. Epub 2009 Feb 5 )