1. Optimal timing of IUI Tansu KÜÇÜK GATA ANKARA

3. Cx Px

4. Natural fecundability Cycle Number of women trying to conceive at start of each cycle Number of pregnancies in study cycle Per cycle pregnancy rate 1200590.30 2137410.30 395160.17 478120.15 566140.21 65240.08 74850.10 84330.07 94020.05 13810.03 113720.05 123510.03 Zinaman et al, Fertil Steril 1996

6. Likelihood of pregnancy 85%

7. Male factor

9. Female’s age (reserve!)

10. Expectant management One year : 14-20% Eimers et al. 1994 Two years: 25-30% Collins et al. 1995 Three years: 60-80% Hull et al 1985; Guzick et al. 1998 Five years: 80% Randolph 2000 Nine years: 64% of primary; 79% of secondary unexplained infertility Jaffe and Jewelewicz 1991

13. it is usually accepted that a 10% success is reasonable for an IUI treatment combined with controlled ovarian stimulation. Ragni et al. Fertil Steril 2004

14. Prognostic fact Indication COS # of insemination Timing Semen preparation Semen qualityPostprocedure rest confounding factors IUI

15. Mis-Timing

16. In stimulated cycles, ovulation usually occurs 36 hours after hCG administration. – Edwards & Steptoe. Proc R Soc Med 1974

20. Double shot Cantineau et al. Cochrane Database of Systematic Reviews 2007, Art No: CD005356 Osuna et al. One versus two inseminations per cycle in intrauterine insemination with sperm from patients’ husbans: a systematic review of the literature. Fertil Steril 2004

21. J Assist Reprod Genet, 2008 Intrauterine insemination: are we doing at the right time? Tansu Küçük Received: 20 January 2008 / © Springer Science + Business Media, LLC 2008 Abstract Purpose To assess whether the timing of intrauterine insemination (IUI) in relation to the rupture of the dominant follicle affects the probability of pregnancy rate after IUI. Material and method Retrospective cohort study. Two hundred ninety-six couples with unexplained infertility and one hundred twenty-one couples with male factor subfertility. Results of 578 cycles were analyzed retrospectively. Result Clinical pregnancy rate was 23.5% (64/272) in the group when follicle rupture was observed by ultrasound, while it was only 8.8% (27/306) when follicle rupture was not evident (p<0.001). Conclusion Postponing IUI until observation of follicle rupture may yield a higher pregnancy rate. Key words IUI, follicle rupture, pregnancy

24. Weathersbee PS, Werlin LB, Stone SC. Peritoneal recovery of sperm after intrauterine insemination. Fertil Steril 1984;42:322- 325 Ripps BA, Mihnas BS, Carson SA, Buster JE. Intrauterine insemination in fertile women delivers larger numbers of sperm to the peritoneal fluid than intracervical insemination. Fertil Steril 1994;61:398-400)

26. LUF Killick et al, Fertil Steril 1997 Qublan et al, Hum Reprod 2006