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IUI - Intrauterine insemination - how to optimise results

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What doctors and patients need to know about using IUI for treating infertile couples

What doctors and patients need to know about using IUI for treating infertile couples

Published in: Health & Medicine

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  • 1. Dr Aniruddha Malpani, MD Malpani Infertility Clinic www.drmalpani.com
  • 2. IUI – the basics Eggs plus sperm = baby !
    • 1. Superovulate
    • 2. Time ovulation accurately
    • 3. Process sperm ( to improve their quality)
    • 4. Insert sperm into the uterus with a catheter
  • 3. The key to success ?
    • What catheter you use ?
    • How many times you do the insemination ?
      • ( double versus single)
    • What sperm preparation technique you use ?
      • wash or swim up or gradient
    • How you superovulate ?
      • Letrozole or clomid or HMG
  • 4. Superovulate ( grow more eggs)
    • Clomid ? Letrozole ?
    • HMG ?
    • FSH ?
    • Recombinant ?
    • How many follicles ?
  • 5. Time ovulation
    • Monitor with ultrasound scans
      • Follicle size and endometrial thickness and texture
      • Optimal follicle size ?
    • Monitor with urinary LH strips
    • HCG injection for inducing ovulation
      • ? GnRH analog for inducing ovulation
  • 6. Timing of IUI
    • Before ovulation ?
    • After ovulation ?
    • How many times ?
      • Single ?
      • Double
    • Intercourse ?
  • 7. How to process the sperm ?
    • Swim up ?
    • Wash ?
    • Culture medium ?
    • With HEPES ?
    • Add Pentoxyfylline to improve sperm motility ?
    • Gradient density centrifugation ?
    • Motile sperm count ?
    • Volume ?
  • 8. Technique of IUI
    • Which catheter ?
      • Soft ?
      • Rigid ?
    • Does the brand matter ?
      • Indian ? Foreign ?
    • Location of catheter tip ?
      • Fundal ?
    • Bed rest after IUI ?
  • 9. The key to success ?
    • What catheter you use ?
    • How many times you do the insemination ?
      • ( double versus single)
    • What sperm preparation technique you use ?
      • wash or swim up or gradient
    • How you superovulate ?
      • Letrozole or clomid or HMG
  • 10. The secret to IUI success ?
    • Patient selection !
  • 11. Major problem with IUI
    • Easy to do
    • Inexpensive
    • Everyone wants to do it
    • Done for all the wrong reasons
  • 12. Unrealistic expectations
    • Patients
      • Eggs plus sperm = baby
      • Expect instant success
      • Get upset and frustrated
      • Lose confidence in doctors
  • 13. Unrealistic expectations
    • Doctors
      • Do not understand limitations of IUI
      • Overpromise – claim success rates of 20%
      • Too many attempts
  • 14. Dangers
    • Multiple pregnancy
    • Infection ( poorly prepared sperm)
    • OHSS
  • 15. Best results when
    • Young patient
    • Good sperm
    • Normal tubes
    • Normal uterus
    • Unexplained infertility
  • 16. Poor results
    • Poor sperm count
    • Older women
    • Poor ovarian reserve
    • Damaged tubes
    • Many previous failed IUI cycles
  • 17. Real life problems
    • Patients run around from clinic to scan center to lab
    • Poor documentation
    • Sperm sample – not seen by doctor or shown to patient
    • Long time delays after sperm is prepared
    • Not on a Sunday !
  • 18. Take home messages
    • Select patients carefully
    • Keep records and analyse them !
    • Do everything under one roof
    • Do not do more than 4 IUIs
    • Know when to refer for IVF