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
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.
Full Bladder and Acutely 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.
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 )