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

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IUI - Intrauterine insemination - how to optimise results

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

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