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IUI - Intrauterine insemination - how to optimise results
 

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

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    IUI - Intrauterine insemination - how to optimise results IUI - Intrauterine insemination - how to optimise results Presentation Transcript

    • Dr Aniruddha Malpani, MD Malpani Infertility Clinic www.drmalpani.com
    • 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
    • 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
    • Superovulate ( grow more eggs)
      • Clomid ? Letrozole ?
      • HMG ?
      • FSH ?
      • Recombinant ?
      • How many follicles ?
    • 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
    • Timing of IUI
      • Before ovulation ?
      • After ovulation ?
      • How many times ?
        • Single ?
        • Double
      • Intercourse ?
    • 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 ?
    • Technique of IUI
      • Which catheter ?
        • Soft ?
        • Rigid ?
      • Does the brand matter ?
        • Indian ? Foreign ?
      • Location of catheter tip ?
        • Fundal ?
      • Bed rest after IUI ?
    • 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
    • The secret to IUI success ?
      • Patient selection !
    • Major problem with IUI
      • Easy to do
      • Inexpensive
      • Everyone wants to do it
      • Done for all the wrong reasons
    • Unrealistic expectations
      • Patients
        • Eggs plus sperm = baby
        • Expect instant success
        • Get upset and frustrated
        • Lose confidence in doctors
    • Unrealistic expectations
      • Doctors
        • Do not understand limitations of IUI
        • Overpromise – claim success rates of 20%
        • Too many attempts
    • Dangers
      • Multiple pregnancy
      • Infection ( poorly prepared sperm)
      • OHSS
    • Best results when
      • Young patient
      • Good sperm
      • Normal tubes
      • Normal uterus
      • Unexplained infertility
    • Poor results
      • Poor sperm count
      • Older women
      • Poor ovarian reserve
      • Damaged tubes
      • Many previous failed IUI cycles
    • 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 !
    • 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