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PROTOCOLS Intra Uterine Insemination (sharing personal experience)

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IUI Effective , non invasive, relatively simple & inexpensive method of treatment.
Can be provided easily in simple setups.

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PROTOCOLS Intra Uterine Insemination (sharing personal experience)

  1. 1. PROTOCOLS Intra Uterine Insemination (sharing personal experience) DR . SHARDA JAIN DR. JYOTI AGARWAL DR. JYOTI BHASKAR …..Caring hearts, healing hands
  2. 2. Effective , non invasive, relatively simple & inexpensive method of treatment. Can be provided easily in simple setups. IUI
  3. 3. PRE REQUISITES FOR IUI • Atleast one patent functional tube • Evidence of ovulation • Adequate sperm count • Responsive endometrium
  4. 4. INDICATIONS OF IUI IN MALE INFERTILITY 1.Ejaculatory failure Anatomical (eg.Hypospadias) Neurological(ex.spinal cord injury ) 2. Retrograde ejaculation (eg. Multiple scerosis) 3. Psychological (eg.Impotence)
  5. 5. Mild Male Subfertility *Hysospermia *Oligospermia *Asthenospermia *Teratozoospermia *Oligostheroteratozoospermia
  6. 6. CERVICAL FACTOR • Cervical mucous hostility •Poor cervical mucus
  7. 7. Immunological • Male antiserum antibodies • Female antiserum antibodies(cervical,serum) • Unexplained infertility • Endometriosis (minimal and mild) • Ovulatory dysfunction • Combined infertility factor • Human immunodeficiency HIV +ve male • Partner and HIV neg female partner
  8. 8. Contraindication • Duration of infertility >7 yrs. • Tubal block or other tubal pathology • Genital tract infections in either partner • Severely abnormal semen parameters • Unexplained genital tract bleeding
  9. 9. • Older women • Sever illness in either partner • Recent chemo/radiotherapy • Multiple failed IUI cycles • Co-existing multiple infertility etiologies Contraindication
  10. 10. STEPS OF IUI 1. selection and counselling about procedure & success rate 2. Protocol ( spontaneous or stimulated cycles) 3.Foliculometry and endometrial thickness 4.Timing of insemination 5.Semen preparation (swim up and density gradient method) 6.Procedure of IUI
  11. 11. IUI IS TIMED 36-40 hrs from the HCG Trigger/24 hrs after LH surge and will be repeated within 12 hrs if the oocyte has not released as yet
  12. 12. Natural cycle IUI • Normal female partner • mild /moderate male factor • Unexplained infertility • Monitor with USG (TVS for follicular maturation • IUI – when mature sized follicle 18-24mm and >7 - 8mm trilaminar endometrium are obtained • Cycle has to be closely monitored with ultrasound & urinary LH every 4-5 hrs.
  13. 13. Criteria for Optimum Ovarian Stimulation for IUI • 2-3 follicles with 18-19 mm • serum E2 levels 150-250 pgm /ml per>15 mm follicles • Endometrium >9mm thick and tri-laminar • IUI between cycle D13 and D16
  14. 14. Cancellation • >6 follicles>15mm irrespective of E2 level • E2>1500pg ml
  15. 15. FEW FACTORS IN MALE EFFECTING IUI SUCCESS
  16. 16. Approximate chance for success getting pregnant with one month of various treatments Female age under 35, 2 years of trying to conceive Type of Treatment Total Motile Sperm Count (in millions) Less than 1 1-5 5-10 10-20 > 20 Intercourse 0.2% 1% 2% 2.5% 3% IUI 0.4% 2% 4% 5% 7% Clomid plus IUI 0.5% 2.5% 5% 7% 9% FSH plus IUI 0.5% 2.5% 6% 9% 12% In Vitro Fertilization - IVF with ICSI* 60% 60% 60% 60% 60% *IVF RESULTS DEPEND UPON THE Protocol & IUI lab of the CLINIC
  17. 17. THE IMPACT OF THE TOTAL MOTILE SPERM COUNT An average total motile sperm count of 10x106 may be a USEFUL THRESHOLD VALUE for decisions about treating a couple with IUI or IVF. Effect of the total motile sperm count on the efficacy and cost- effectiveness of intrauterine insemination and in vitro fertilization. Van Voorhis BJ, et al. Fertil Steril 2001 Apr;75(4):661-8
  18. 18. SPERM QUALITY NECESSARY FOR SUCCESSFUL INTRAUTERINE INSEMINATION • Initial sperm motility  30% • The post wash total motile sperm count  5 X 106 is critical • When initial values are lower, IUI has little chance of success Comparison of the sperm quality necessary for successful intrauterine insemination with World Health Organization threshold values for normal sperm. Dickey RP, et al. Fertil Steril 1999 Apr;71(4):684-9
  19. 19. SPERM-PREPARATION TECHNIQUES- IUI RESULTS •ABNORMAL SEMEN ANALYSES. –Density gradient is superior to the swim-up technique in improving AR, HOS and nuclear maturity rates. • NORMAL SEMEN ANALYSES. –When only nuclear maturity rate is taken into account, the swim- up technique seems to be sufficient for selecting spermatozoa. Sperm-preparation techniques for men with normal and abnormal semen analysis.- A comparison. Erel CT, et al. J Reprod Med 2000 Nov;45(11):917-22
  20. 20. SPERM DNA FRAGMENTATION decreases the pregnancy rate in an Assisted Reproductive Technique Mehdi Benchaib et al.Reproduction Vol.18, No.5 pp. 1023±1028, 2003 What is New ?
  21. 21. *Patient may have normal semenology and have HIGH DFI (DNA fragmentation index) or * A very poor count and motility yet better DFI. Principle of DNA Fragmentation
  22. 22. Many cases of unexplained infertility who are unable to conceive by IUI,IVF/ICSI can do better * after treatment of causative factors of Abnormal DFI or * by Testicular Extraction of sperm and ICSI UTILITY OF DNA FRAGMENTATION TEST
  23. 23. INDICATIONS FOR REFERRAL to an IVF centre 1. Higher age group>37 yrs. 2. more than 4 cycle failed IUI 3. Severe male sub-fertility 4.No.of mature follicles >6 Number of intermediate follicles >10 5. Moderate to severe endometriosis 6. Need for cryopreservation of semen
  24. 24. IMPORTANT TIPS To DECIDE -WHEN TO MOVE FROM IUI TO IVF? Each centre should define its policy when to switch for IVF, which takes into account •Diagnostic laboratory techniques available, •Selection of protocols •Sperm washing techniques – when to use what •Pregnancy rates achieved by IUI clinic •Sensibility of the treated population
  25. 25. ADDRESS 11 Gagan Vihar, Near Karkari Morh Flyover, Delhi - 51 CONTACT US 9650588339 9599044257 011-22414049 WEBSITE : www.lifecareivf.in www.lifecarecentre.in www.lifecareabs.in ISO 14001:2004 (EMS) …..Caring hearts, healing hands ISO 9001:2008 Helpline : 9599044257 Web.www.lifecareivf.in Helpline : 9910081484 26 Year In your service

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