IUI, DIPI, IUI/DIPI

The three types of insemination performed at the Centro Demetra (Intrauterine Insemination 
- IUI -, Intraperitoneal Insemination - DIPI -, and Intrauterine/Intraperitoneal Combined Insemination - IUI/DIPI) differ only in the female genital apparatus location where the male partner sperm is deposited, previously treated in the laboratory. In the case of IUI the deposit takes place directly inside the uterus ; in DIPI the sperm is deposited directly in the peritoneal space ; in IUI/DIPI sperm is simultaneously deposited in the uterus and in the peritoneal space . 
It is evident that the direct insertion of sperm in the uterine cavity (IUI) has the advantage of avoiding the sperm transport towards the oocyte to be fertilized .
It seems more difficult to understand the advantage of the insertion of sperm in the peritoneal space during the DIPI .
However, it has been demonstrated that sperm directly inserted in the peritoneal space is able to reach the Fallopian tube lumen in a short period of time, through a pathway that is opposite to the usual direction, and in this manner get to the oocyte ready to be fertilized. 
Based on the above considerations it is understandable that the main indications of insemination are:
- idiopathic sterility;
- infertility secondary to mucus-semen incompatibility (since sperm is inserted beyond the obstacle created by the cervical mucus in both IUI and DIPI);
- male sterility (dyspermia); in this case, the deficit in number and/or motility of the partner's sperm are overcome by the insertion of the sperm in the vicinity of the oocyte or by pretreatment of the male semen in the laboratory.
In general, the first technique used is IUI, which is less invasive for the patient. In case of lack of success IUI/DIPI are performed to strengthen the maximal chance of sperm and oocyte encounter. DIPI is chosen in case of severe cervical stenosis impeding the access to the uterine cavity.
All the inseminations are performed after ovaric stimulation of the female partner; the purpose of this stimulation is to render the female partner more fertile to increase success possibilities. In general in the first trials ovaric stimulation is mild, performed with indirect ovulation inductors (usually Clomiphene citrate); if more trials are needed (in general no more than six) ovulation induction is performed with gonadotropins, eventually associated to GN-RH analogs or more recently to Gn-RH antagonists. In most cases the first try is with the simplest insemination type, the IUI, associated with Clomiphene citrate; in case of failure, the next try is performed with IUI/DIPI associated with ovulation induction with gonadotropins, alone or in combination with GnRH analogs or Gn-RH antagonists. The choice of ovaric stimulation type is in any case based upon a detailed evaluation of the clinical and endocrine characteristics of the patient. 
Once the type of stimulation has been chosen, the ovaric response is accurately followed by means of daily ultrasound imaging to control the growing of the ovaric follicles; when gonadotropins are chosen for stimulation, ultrasound monitoring is accompanied by circulating hormonal measurements (daily assessment of 17-b -Estradiol plasma levels), which are performed in a highly specialized laboratory: Check-up (Palermo, Via E. Parisi n.40) directed by Dr. Gaspare Accardi. When the results of ultrasound and hormonal evaluation indicate that the patient is ready, insemination is performed at Centro Demetra; all types of insemination (IUI, DIPI, IUI/DIPI) are no distressing for the patient who after 20-30 minutes may go back home.