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What doctors and patients need to know about using IUI for treating infertile couples
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Dr Aniruddha Malpani, MDMalpani Infertility Clinicwww.drmalpani.com
IUI – the basicsEggs plus sperm = baby !
1. Superovulate2. Time ovulation accurately3. 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 ovulationMonitor with ultrasound scans
Follicle size and endometrial thickness and texture
Optimal follicle size ?Monitor with urinary LH stripsHCG injection for inducing ovulation
? GnRH analog for inducing ovulation
Timing of IUIBefore 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 IUIWhich 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 IUIEasy to doInexpensiveEveryone wants to do itDone 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
DangersMultiple pregnancyInfection ( poorly prepared sperm)
OHSS
Best results whenYoung patientGood spermNormal tubesNormal uterusUnexplained infertility
Poor resultsPoor sperm countOlder womenPoor ovarian reserveDamaged tubesMany previous failed IUI cycles
Real life problemsPatients run around from clinic to
scan center to labPoor documentationSperm sample – not seen by doctor
or shown to patientLong time delays after sperm is
preparedNot on a Sunday !
Take home messagesSelect patients carefullyKeep records and analyse them !
Do everything under one roofDo not do more than 4 IUIsKnow when to refer for IVF