Patient selection and work-up
Ovarian stimulation
Monitoring of follicular growth and endometrial development
Timing of insemination
Number of inseminations
Semen preparation
Insemination procedure
Luteal support
Since the first formal description of LPD in 1949 as a possible cause of infertility and recurrent miscarriage by Jones. Innumerable investigations have been undertaken in an effort to verify its existence or to characterize its pathophysiology, diagnosis, and treatment. The consensus of the literature is that LPD does exist and that its cause is multifactorial like abnormal folliculogenesis, inadequate LH surge,inadequate secretion of progesterone by the corpus luteum, aberrant end-organ response by the endometrium.
Since the first formal description of LPD in 1949 as a possible cause of infertility and recurrent miscarriage by Jones. Innumerable investigations have been undertaken in an effort to verify its existence or to characterize its pathophysiology, diagnosis, and treatment. The consensus of the literature is that LPD does exist and that its cause is multifactorial like abnormal folliculogenesis, inadequate LH surge,inadequate secretion of progesterone by the corpus luteum, aberrant end-organ response by the endometrium.
Vasundhara Hospital Jaipur is a premier specialty hospital for infertile couples, complete women care, high risk pregnancy management, located in heart of Jaipur.
Click to more info :- https://www.vasundharafertility.com/jaipur
Significant increase in live birth rate is found when IUI is done with stimulation compared with IUI in natural cycle in women with Unexplained Infertility .
Dr Sujoy Dasgupta moderated a Panel Discussion on "Difficult cases in IUI" in the Annual Conference of ISAR (Indian Society of Assisted Reproduction), Bengal held in December, 2022
Antagonist - Tips and tricks to optimize use in Intra Uterine Insemination (I...Anu Test Tube Baby Centre
Presentation given in 2017. Management of infertility using assisted reproductive technologies.
What is the role of antagonist in IUI and IVF - tips and tricks to optimize its use.
Ovulation Induction - Simplified - Dr Dhorepatil BharatiBharati Dhorepatil
What are factors to be considered
Ovarian reserve
Previous ovarian response
Basic hormone profile
Role of FSH & LH
Trigger
Luteal phase support
Pregnancy rate/cycle
Vasundhara Hospital Jaipur is a premier specialty hospital for infertile couples, complete women care, high risk pregnancy management, located in heart of Jaipur.
Click to more info :- https://www.vasundharafertility.com/jaipur
Significant increase in live birth rate is found when IUI is done with stimulation compared with IUI in natural cycle in women with Unexplained Infertility .
Dr Sujoy Dasgupta moderated a Panel Discussion on "Difficult cases in IUI" in the Annual Conference of ISAR (Indian Society of Assisted Reproduction), Bengal held in December, 2022
Antagonist - Tips and tricks to optimize use in Intra Uterine Insemination (I...Anu Test Tube Baby Centre
Presentation given in 2017. Management of infertility using assisted reproductive technologies.
What is the role of antagonist in IUI and IVF - tips and tricks to optimize its use.
Ovulation Induction - Simplified - Dr Dhorepatil BharatiBharati Dhorepatil
What are factors to be considered
Ovarian reserve
Previous ovarian response
Basic hormone profile
Role of FSH & LH
Trigger
Luteal phase support
Pregnancy rate/cycle
Ovulation Stimulation Protocols for IUI - Dr Dhorepatil BharatiBharati Dhorepatil
What are important factors to be considered important
Ovarian reserve
Previous ovarian response
Basic hormone profile
Role of LH
Trigger
Luteal phase support
Pregnancy rate/cycle
Update on LETROZOLE Current Guidelines for Ovulation Induction Dr. Sharda Jain Lifecare Centre
Update on LETROZOLE Current Guidelines for Ovulation Induction
LET NOT FORGET
WHY
??
LETROZOLE was withdrawn from
Indian market (2012)
“SAFETY ISSUES”
“Could Be Teratogenic In Human”?
PCOD,How are they different ??Difficulties & Solutions made Easy , Dr. Sharda...Lifecare Centre
Tremendous advances and extensive human studies have uncovered the complexity and management of PCOD
Global prevalence -2.2% to 26% Roughly 1 in 15 women worldwide, (Lancet, 2007)
Explore the intricacies of ovulation induction in intrauterine insemination (IUI) with Dr Laxmi Shrikhande's informative slide share presentation. From understanding the hormonal mechanisms to the latest techniques, this presentation offers insights into optimizing fertility through IUI. Whether you're a clinician seeking to enhance patient outcomes or an individual navigating fertility treatments, this resource provides valuable knowledge for your journey towards conception.
“Inheritance” in images, from Darwin’s “tree of life” to DNA’s iconic crystallography to the epigenetic dynamicsHowever, the script needs to be interpreted and receives meaning only from the interplay with the environment
THE ASSISTED REPRODUCTION TECHNOLOGY REGULATION RULES, 2010
Members of drafting committee11 members
1- Sr Advocate Supreme Court of India
2 – Public Interest Legal Support and Research
3 – Dept of Family Welfare, M of Fam Wel and Research
5 – experts from the field of Reproductive Medicine
Ovarian Drilling Do's & Don'ts - By Dhorepatil BharatiBharati Dhorepatil
Rotterdam Criteria 2003
The Thessaloniki ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group
March 2–3, 2007, Thessaloniki, Greece.
Human Reproduction 2008
Luteal Phase - Clinical Point of View - By Dr Dhorepatil BharatiBharati Dhorepatil
Maintenance of pregnancy
Corpus luteum Progesterone
After ovulation ~ during the early first trimester ~ until placental function established
Removal of the corpus luteum spontaneous pregnancy loss
Ovarian progesterone production implantation & early pregnancy
Role of decreased androgens in the ovarian response to stimulation in older women
Part I: Effects of testosterone (T) on preantral and antral follicles
Part II: How to improve ovarian response ?
Exogenous testosterone
DHEA
Aromatase inhibition (AI)
LH/HCG
Growth hormone (GH) / IGF-I
Indivisualization of Ovulation Induction - Dr Dhorepatil BharatiBharati Dhorepatil
IVF started to develop fast with the aim of maximizing pregnancy rates per cycle
Higher number of oocytes and thus more embryos
Use of unphysiological high doses of gonadotropins
Time consuming protocols
Higher costs
Patient discomfort
Higher risk of OHSS
Very high risk of multiple gestation
MONITORING PITUITARY DOWN-REGULATION
If GnRH Agonist is started in the late luteal phase a menstrual bleeding normally indicates that the estrogen is low and FSH can be started.
Blood tests will clearly confirm down-regulation – ovarian/pituitary hormones.
Ovarian reserve tests provide an indirect measure of the cohort of recruitable antral follicles present in the FSH window at the beginning of each menstrual cycle..Functional Ovarian Reserve
Why we need to predict?
Hormone defects may cause severe neurological, metabolic or cardiovascular consequences and lead to the early onset of osteoporosis
Psychological Depression
Low levels of self esteem and Life satisfaction
Sexual Dysfunction
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
We understand the unique challenges pickleball players face and are committed to helping you stay healthy and active. In this presentation, we’ll explore the three most common pickleball injuries and provide strategies for prevention and treatment.
CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
QA Paediatric dentistry department, Hospital Melaka 2020Azreen Aj
QA study - To improve the 6th monthly recall rate post-comprehensive dental treatment under general anaesthesia in paediatric dentistry department, Hospital Melaka
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
Telehealth Psychology Building Trust with Clients.pptxThe Harvest Clinic
Telehealth psychology is a digital approach that offers psychological services and mental health care to clients remotely, using technologies like video conferencing, phone calls, text messaging, and mobile apps for communication.
3. Patient selection and work-up
Ovarian stimulation
Monitoring of follicular growth and
endometrial development
Timing of insemination
Number of inseminations
Semen preparation
Insemination procedure
Luteal support
4. Age < 40 years
Patient capable of spontaneous or induced
ovulation
Atleast one patent fallopian tube with good
tubo- ovarian relationship
Sperm count of more than 10 million/ml
pre-wash or a post-wash count of >3-5
million motile sperms with percentage
motility of more than 40%
Easy access to the uterine cavity via a
negotiable cervical canal
5. Controlled ovarian stimulation along with
intrauterine insemination –effective form of
treatment - select group of couples.
8. Unexplained infertility
Cervical factor, Antisperm antibodies
Ovulatory dysfunction (ovulating but no
pregnancy and associated with male
factor-ESHRE/ASRM)
Minimal to mild endometriosis
Vaginismus
Allergy to seminal plasma
10. Severe abnormal semen parameters.
Azoospermia.
Hereditary disease in male.
Repeated failure at IVF/ICSI.
11. Tubal pathology
Genital tract infection
Severe male factor infertility
Severe endometriosis
Genetic abnormality in husband
Unexplained genital tract bleeding
Older women more than 40 years
Multiple failures at IUI
12. Oral drugs
Oral drugs with gonadotropins
Gonadotropins alone
Gonadotropins with Gnrh analogs
Gonadotropins with Gnrh antagonists
14. Maximizes conception- ideally expressed
as singleton live birth at term.
Minimizes multiple pregnancy and OHSS.
Avoiding risks of preterm delivery, perinatal
morbidity and mortality to the neonate and
risks to the mother from OHSS
15. Basic protocol
DAY 3-5
Ultrasound- AFC , ENDO , CYST
Dose 50mg
Sexual relation every other day from day
10 onwards
If menses occurred within usual frame
work of 26-32 days- ovulation is assumed
to occurred.
If no ovulation then increase 50 mg tab
each succeeding cycle
16. Effectiveness and safety of OI are increased.
Starting day determined by day 2 -E2 and P4.
Initial dose according to body weight.
Monitoring by USG and E2 levels.
Day and Time of IUI or timed intercourse-
regulated by triggering ovulation with HCG .
17. PCOS -Ovulation in 60-80% and conception
rate of 50%-60% for upto 6 cycles
(ESHRE/ASRM GUIDELINE on PCOS-2008)
Overall cycle fecundability is 15%-22% in those
ovulating with CC in first 3 cycles .
(Eijkeman---Human Rep 2003)
Unexplained infertility-CC alone-5%, CC+IUI-
10%
(Deaton etal-fert ster 1990)
19. Extended course---50% who are resistant may
respond to 7-10 day course .FDA approves only
750mg of CC per treatment cycle.
(Isac etal-Fert stert 1997).
CC+ Glucocorticoids
Continuous/follicular phase
Prednisolone-5mg or dexa-0.5-2mg/day -
normal or raised DHEAS level- increased
ovulation(75-80%) and pregnancy rates(40-
40.5%)
(RCT-Parsanezhad etal-fert stert 2002, human
reprod 2006 .)
20. Preliminary suppressive therapy -in
women with excess LH and androgen
levels-continuous OC pills for 2
months(70% ovulation rates and 50%
pregnancy rates)
(Branigan etal RCT Fert stert 2003)
Gnrh alone or in combination with OC
pill can also be used.
(Genazzani—J Asst rep gen 2000)
21. No evidence of difference in live birth
rate comparing Metformin plus CC with
CC alone(meta analysis 2007 ).
Highly effective in achieving ovulation
induction in CC resistant cases (fertil
steril 2006 )
Metformin with gonadotropin did not
improve ovulation or pregnancy rates
but did reduce risk of OHSS. (RCT hum
reprod 2006 )
22. Metformin treatment for 12 weeks before and
during IVF or ICSI in non-obese women with
PCOS significantly increases pregnancy and
LBRs compared with placebo. However, there
was no effect on the outcome of ART per se.
(randomized,multi-centre study 2011 )
Metformin is still of benefit in improving clinical
pregnancy and ovulation rates although no
clear evidence exists that metformin improves
live birth rates (LBRs) whether it is used alone,
in combination with clomiphene or compared
with clomiphene. Cochrane analysis (Tang et
al., 2010)
23. May have a role in OI after CC failure or as
first line.
Similar in efficacy to CC in terms of ovulatory
rates.
(Nikolaos etal-systematic review reprod
biomed online-oct-2009)
ESHRE/ASRM consensus-
Off label option, currently not licensed for use
in infertility . Further studies are needed
regarding safety before wide spread use .
24. The long letrozole protocol (10 days)
can produce more mature follicles and
subsequently more pregnancies than
the short letrozole therapy (5 days).
(Fertil Steril_ 2009 )
use of higher doses of letrozole offers
no advantage in terms of pregnancy
rates over the lower (2.5 mg)
dose(2007 Reproductive BioMedicine)
25. Aromatase inhibitors are as effective as
or superior to CC in ovulation induction
and in superovulation. Unlike CC, they
do not carry an antiestrogenic effect on
the endometrium. Given the
advantages of aromatase inhibitors,
they can be used to replace CC as
ovulation-inducing drugs. (Fertil Steril_
2006.)
26. The step-up letrozole protocol was
associated with multifollicular ovarian
development similar to CC. Higher
clinical pregnancy rate/treatment cycle
compared with CC was also observed
with the letrozole step-up treatment
(27.3% vs. 11.8%).
Pregnancy rates treated with CC and
LET were identical . (RCT FERTIL STER
2007 )
27. Concurrent protocol
Overlap protocol
Sequential protocol
Cycle fecundability better than CC alone
(Dickey et al-Human rep 1993)
Monitoring similar to gonadotropin cycle
Lower incidence of multiple pregnancy
(Ron et al Human rep 1989)
28. GROUP I
CC RESISTANT(15-25%)
50% of PCOS women who have undergone LOD
need CC or gonadotropin
If no ovulation after 6 months use CC for
stimulation (ESHRE/ASRM in PCOS-2008).
CLASS IV - if intolerant to dopamine agonists.
30. Initial daily doses of 2 amp of HMG used,
(150IU FSH) increased by >50% every 3-5
days until an ovarian response occurs.
It is effective but is associated with
increased rate of OHSS and multiple
pregnancy
Disadvantage- does not take into account
the difference in the response of the follicle
to FSH and LH.
32. Low initial daily FSH of 75IU and the dose
is increased by small amount usually
37.5IU/day
Starting dose may be lower – clinical
features, previous OHSS, history of
multiple follicles developing in the first
week.
The first increase in dose is done only after
14 days
33. CYCLE DAY3 -75 IU FSH/DAY
7 DAYS
7 DAYS
Follicle<10 mm Maintain dose
Follicle<10 mm ,increase
dose By 37 .5 IU/day
Follicle > 10mm
Follicle> 10mm
Maintain Dose until follicle>mm
HCG Injection
7 DAYS
Follicle<10 mm ,increase
dose By 37 .5 IU/day weekly
to a max. of 225 IU/day
Follicle > 10mm
Follicle<10mm
Cancel cycle
Start new cycle
Increasing starting dose by 37.5
IU/day
Follicle>10mm
34. Gonadotropins have a very narrow therapeutic
range.
These regimens allow FSH to rise slowly to just
above the threshold level and at the same time
avoiding the explosive ovarian response.-
Threshold concept(BROWN etal)
Initiation of follicular growth requires only 10-
30% of increase in the dose of exogenous FSH
35. Low complications of OHSS and multiple
pregnancy and fair pregnancy rates.
Pregnancy rate of 10% per initiated cycle
with a mean rate of 0.3% of higher order
multiple pregnancy.
(Ragni etal-6670 IUI cycles-Fert ster
2006)
36. Cycle day 3: 150-250 IU FSH/day/5 days
Ultrasonography (every 2-3 days)
Follicle> 9mm Follicle< 9mm
Decrease 37.5 IU/day every 3 days Increase 37.5 IU/day maintain 10 days
Maintain 75 IU/day
Until HCG injection
Follicle>9mm-------Follicle<9mm
Cancle cycle
STEP DOWN PROTOCOL
37. Concept-approximate physiologic
circumstances mimicking natural intercycle
FSH elevation and the subsequent
decreasing dependence of the DF on FSH.
Duration rather than the magnitude of FSH
increase affects follicle development
38. Monitoring is more intense .
Difficult to judge the correct dose reduction
in daily clinical practice.
Protocol is effective but the rate of OHSS
is more compared to step up regimen.
39. Low dose step up regimens are superior to step down
regimens in terms of mono folliculogenisis, ovulation
rates and ovarian hyperstimulation in PCOS
(Christian Maitre –RCT stepup Vs stepdown in PCOS-
Huma rep-2003)
Step up regimen-duration of therapy and the amount of
gonadotropins required are more compared to step down
regimens
Even in step up regimens results are better if the starting
dose is low and the increments are also smaller doses
40. Combines an initial step up followed by a
step down regimen after follicular selection
(leading follicle >14mm ).
42. Starting dose is 37.5-50 IU/day.
Adherence to the 14 day starting period in
atleast the first cycle is less likely to result in
excessive stimulation.
Small FSH dose increments of 50% of the initial
or previous FSH dose.
Duration not to exceed 6 ovulatory cycles
Intense ovarian response monitoring.
Strict cycle cancellation criteria should be agreed
upon with the patient before therapy is started.
43. 43 RCT TRIALS- 3597 WOMEN
- Gonadotropins Vs Antiestrogens-significant increase in
pregnancy rates(OR-1.8)
- Anti estrogens Vs Aromatase inhibitors -no significant
difference in pregnancy rates(OR-1.2,CI-0.65 to 2.1)
- Gonadotropins Vs Gonadotropins – no difference
- Addition of Gnrh agonist-No increase in pregnancy rates
but increase in OHSS.
- No evidence for the addition of Gnrh antagonist to
gonadotropins
44. HCG
Gnrh AGONIST
Recombinant HCG.
Routine administration of HCG adds little
to improving conception rates .Indicated
only when absent or delayed ovulation or
for timing IUI or intercourse.
(Fertil steril 2007)
46. Single IUI.
36 hrs after HCG .
After follicle rupture .
Within 24 hrs of LH surge.
Double IUI.
At 24 and 48hrs after HCG adminst.
Day 6 and day 8 of last pill .
NO statistical difference in pregnancy rates in
different timing regimens.
(Esra et al –Fert ster 2009)
47. RATIONALE-increase opportunity for longer
fertilisation period (22-47hrs).
No clear benefit in terms of LBR.
(TafunBagis etal-Human rep ,may 2010)
Systematic review of 3RCT-No difference.
(NICE guideline-fertility-2004)
No clear benefit in terms of pregnancy rates.
(meta analysis-Nikalaos-Fert stert Aug.2009.)
48. Pre- ovulatory USG.
Fresh unwashed semen- 6-8 hrs before
ovulation.
Washed semen –No sooner than 4 hrs
after ovulation.
Cryopreserved semen – As close to
ovulation.
LH testing kit.
Within 24 hrs of color change .
50. The patient is positioned .
Cervix exposed with cuscos bivavle
speculum, excessive vaginal secretions
are wiped away and the cervical os is
cleansed with the standard buffer solution
using a cotton swab.
IUI cannula is flushed with 1-2 ml of
flushing media to wash away any toxic
factors present.
51. Specimen ( 0.4- 0.5ml) drawn into the
catheter and syringe.
The catheter is gently introduced into the
cervix to pass beyond cervical os until the
catheter enters the uterus.
The catheter is advanced to a depth of at
least 4cm but no more than 6cm to avoid
trauma to the endometrium
When the catheter is in place and before
ejecting the specimen , the opened forceps is
positioned on either side of the cervix and the
opposing ends gently squeezed together with
just enough pressure to prevent fluid
escaping .
52. • The specimen is slowly ejected from the
syringe.
• The air remaining in the syringe is
expressed as the catheter is withdrawn, to
form an air block in the cervix.
• Pressure on the forceps should be
maintained until the cramping subsides,
usually within one minute
53. 2 ml of buffered solution is drawn up into
the syringe before drawing up the
specimen suspended in 0.4- 0.5ml wash
media
The specimen and buffered solution are
injected slowly
The specimen propelled by the 2ml of
media, will fill the endometrial cavity and
partially fill the fallopian tubes.
54. FSP involves injecting 4.0 or 6.0 ml of a
washed specimen under pressure while
sealing the cervix to prevent reflux.
Increasing the insemination volume to 10
ml ensures peritoneal delivery of sperm
FSP resulted in significantly higher
pregnancy rates than IUI. ( cochrane
database 2004 ).
55. 15 min of bed rest after IUI has shown to
improve ongoing pregnancy and LBR
(RCT-Custers etal BMJ2009).
56. 08 -14% per cycle for all causes of infertility.
Semen parameters- count , motility and
morphology
(Van etal—fert&ster 2001)
(lee etal –int.j.andr,2002)
57. Age
Semen source and quality
No of follicles
Reason for treatment
Previous treatment cycles
58. Threshold
Pre wash
Total count- 10 million
Motility -30 %
Total motile forms- 5
million
Morphology - 5%
8% VS 2.5%
Pregnancy rate per
cycle
Post wash
4 – 5 million
50 %
59. COH WITH IUI CC WITH IUI P VALUE
WHO 18.4 % 12.9 NS
IUI-THRESHOLD 16.9 11.4 NS
SUB- IUI
THRESHOLD
8.9 3.2 <O.OO1
DONOR 22.2 16.5 NS
60. COH WITH IUI CC WITH IUI P VALUE
<32 19% 14.6 NS
32-34 19.2 13.9 NS
35-37 16.1 11.8 NS
38-40 12.9 12.1 NS
41-43 6.0 3.8 NS
61. COH WITH IUI CC WITH IUI P VALUE
CERVICAL ,
UNEXPLAINED
19.2 % 14 NS
OVULATORY
DYSFUNCTION
19.5 14 NS
ENDOMETRIOSI
S
16.1 7.9 <O.OO1
DICKEY ET ALL
2005
62. COH WITH IUI CC WITH IUI P VALUE
1 11.3 % 9.8 NS
2 13.2 14.3 NS
3 16.8 17.7 <O.O1
4 19.7
5-6 21.8
7-8 22.0
>9 26.0
63. COH WITH IUI CC WITH IUI P VALUE
First 16.4 % 10.4 NS
Second 15.1 9.1 NS
Third 10.9 8.9 NS
> Fourth 4.6 2.8 <0.005
64. Luteal support in IVF cycles is associated with
increased pregnancy rates
Luteal support is necessary when Gnrh
agonist,hcg and antagonist is used.
Luteal support in the form of various forms of
progesterone and hcg can be given depending
on the clinical situation.
65. Oral dydrogesterone 10 mg bd from day of
IUI.
Micronized progesterone 100 mg bd orally
or vaginally.
Inj. Hcg 3000iu i.m. once every 3days.
Role of estradiol is not clearly defined.
66. Failure of treatment
Pelvic infection: 0.01-0.2%
Uterine contractions and anaphylaxis
OHSS < 1%
Multiple pregnancy
Ectopic pregnancy
Miscarriages
Pain and vaso vagal attack