Second Secret: Patient Selection.
A complete work up of both husband and wife is essential before embarking on IUI.
Factors which need to be considered are: Age ( Both Husband and Wife), Ovarian reserve, Endometrial response and Semen Factors.
Age is one of the most powerful variable to impact the success of IUI.
Good responders are those who are young with Good AFC count, ET more than 7mm and good post wash sperm count and motility and sperm survival at 24 hrs. (over 80% )

Third Secret: Success Rate
It is imperative that Infertility Clinics/IVF centres display and counsel the couple of the success rate of individual ovarian stimulation protocol. No body should go with idea that it is 100%
Combining ovarian stimulation with IUI improves pregnancy from 6-22%.
With CC and IUI pregnancy rate is 8% and it increases to 18-20% when gonadotrophins and antagonist are used with IUI.

Fourth Secret: Endometrial thickness.
Ideal endometrial thickness at time of IUI is 7-10mm ( triple line).
In case of poor ET, measures like delayed trigger till follicle is 24mm( CC cycle), using gonadotrophins, scratching endometrium and using drugs like estrogen, aspirin, sidnafil , Viagra can be undertaken.

Fifth Secret: Follicle Monitoring
Follicle monitoring should be done by TVS by the same Infertility Expert at the ART/IVF centre only.
It helps to modify the protocol, assess endometrial thickness, follicle growth and time HCG trigger.

Sixth Secret: HCG trigger
Correct timing of HCG Trigger is essential for good results.
Using Doppler with follicle trigger can even help us time the trigger more accurately and precisely.
In a CC cycle, HCG should be given when follicle is 22-24 mm while in a GT cycle at 17-18mm.
IUI is done 38-40 hrs later. IUI done post ovulation only is key to success. Double IUI offers no advantage over Single IUI except in cases of AID and male factor infertility.

Seventh Secret: LAB Secrets
Meticulous semen preparation using appropriate technique according to semen assessment, use of high quality consumables and media, are the main stay of IUI.
It is a must that Semen is prepared in the same office where IUI is being done. Transit time leave motile sperms but no pregnancy rates if IUI specimen is not processed in inhouse.

Eigth Secret: IUI Technique
Expertise, precision and looking into fine details of the technique of IUI improves pregnancy rates…..Experience and adherence to checklists and protocols enhance the efficacy of IUI.

Ninth Secret: Luteal Phase support
Use of vaginal micronized progesterone is ideal and effective when stared from day of IUI to improve implantation rates.
Tenth Secret: Counselling & documentation
Taking the couple into confidence, transparency and frequent communication goes a long way in improving IUI success rates. Even more essential is to know when to stop doing further IUI and move on to IVF.
3 good IUI cycles are equal to 1 IVF cycle.
It is good to remember for time to time, it is good to review patients records, what works with you and what does not work!!.

• Quality of the Women’s Egg
• Quality of the Man’s Sperm
• Receptivity of the Uterus

Are the Three Ultimatums for the IUI Success!!
These secrets of protocols, maintaining evaluation & special techniques should be sincerely and meticulously followed as to have good pregnancy outcome