New Method of Insemination - IntraUterine TuboPeritoneal Insemination (IUTPI) PDF Print E-mail

 

History of the Method

For several years, Kahn’s method of insemination, with 4ml of inseminate, was used in our Clinic, being an improved method of the standard Intrauterine Insemination, with 0,5 – 1ml of inseminate.  Our results in using Kahn’s method were published in the medical journal  Human Reproduction, in 1996.


The quantity of 4ml of inseminate, was not always sufficient, however, since the pressure built in the uterus by this amount, was not enough to promote the sperm through the openings and into the fallopian tubes. It was decided, thus, to gradually increase the amount of inseminate injected to 6ml, 8ml and, finally, to 10ml.  Moreover, 10ml of contrast medium is used by radiologist for HSG, since this amount is sufficient to fill the uterine cavity and enable the imaging  of the fallopian tubes and the peritoneum.


The use of 10ml of inseminate showed a significant increase in pregnancy rates, so it was decided to apply it on a regular basis. This new method was named Intrauterine Tuboperitoneal Insemination (IUTPI for short) because the injected inseminate, passes through the uterus (Intrauterine) into the fallopian tubes (tubo) and reaches the peritoneum (peritoneal) and the pouch of Douglas. The whole procedure is made possible with the effective sealing of the cervix achieved by the specially designed medical instrument, the DNB cervical clamp.


To confirm the reliability of the method, a randomized study was designed, applied in our Clinic and published in the medical journal Fertility and Sterility, in 2006. Women who participated in the study were randomly allocated in either the 4ml group or the 10ml group. The 10ml group pregnancy rates were significantly higher to those of the 4ml group.      


Couples with low sperm count who did not want to proceed to IVF or had already had one or more unsuccessful attempts, were treated with the new method of insemination, the IUTPI. Furthering our study, it was decided these couples (with low sperm count) to proceed to sperm pooling, that is, adding 2 -3 sperm samples together before insemination.  In this way, the overall number of spermatozoa was sufficiently increased resulting in higher pregnancy results. These very encouraging results were presented at the European Andrology Congress in Athens (2010). 


 Furthering our research  on sperm concentration (sperm pooling), couples with moderate sperm count were added to the study aiming to the increase of the number of spermatozoa before IUTPI. A presentation is expected.


The method is already in use in Centres abroad, whereas the innovative Cervical Clamp (DNB Speculum) received a free sale permit by the Greek Organization of Drugs (as a medical instrument) and is exported internationally.

 

IntraUterine TuboPeritoneal Insemination  (IUTPI)

 

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. The promising results of  IUTPI< the new L. Mamas insemination method, were published in the medical journal 'Fertility and Sterility', March 2006 issue.  (.pdf)