Transcript PPT

10 secrets of success of IUI
Dr. Sharda Jain
Programme Director
st
1
Secret
Right choice based on facts
(Actiology)
Good Result : - Unexplained I
: - Cervical Factor I
: - Anovulatory I
: - Donar IUI
Poor Results
:- severe male infertility
tubal factor/
pelvic adhesions
severe endometriosis
2nd secret
Understand The Case (H & W)
•
•
•
•
Age – women & men
Ovarian response (Poor /High/ Normal)
Endometrial Response
AMH
Good Responders :- young
:- Good Crop of
Preovulatory follicles
:- Good ET (> 7 mm)
:-
Good PMS count
Poor Responders
:- Older self / partner,
:- ↑ duration infertility (> 5 yrs)
:- Poor OR
:- Poor ET
:- Poor Sperm Quality
Male
Male age - < 35 yrs
> 45 yrs
>10 million prewash count
5-10 million Post Wash Count
Normal morphology – 14% (Krugers)
DNA fragmentation - 30 %
Sperm survival (24 hours) - ↑ 80%
3rd secret
Individualised Ovarian Stimulation Protocol
• Typical PR
4 / 8 / 12 / 20
• GT
• Antagonist in IUI protocol
4th secret
Poor Endometrial Thickness
• CC – neg. effect on ET – EV ?
• Delay trigger
• GT
• Scratching of Endometrium
• ↑ Endo Vascularity
(Aspirin/ Viagra / Sidnafil)
5th secret
Follicle Monitoring
Do it your self
Modify Dose / ET / Follicle size / HCG Trigger
- GT
- EV
6th secret
Do Right Thing at Right Time
Trigger when
GT – 17-18 mm
CC -24 -25 mm
Doppler – Perifollicular perfusion 50 – 70 %
RI < 5
PSV > 11
S/C HCG – (BMI)
Agonist trigger - OHSS
Timing of IUI – 38 hours
Single
– No Male Factor
Double IUI
– Male factor, PSV > 20
1st 16 - 18 hrs
2nd 36 – 38 hrs
+ LH surge - Give HCG trigger immediately
- IUI 24 hrs
7th secret
Lab secret
• Labeling
• Abstinance (<3 V/S > 10 days)
• Semen collection
• Semen preparation
One size does not fit all
• High quality Consumables & media
Preparation in doctor’s office must
8th secret
Success lies in looking into details of techniques
•
•
•
•
•
•
•
Full Bladder
Cx mucus aspiration
Targets time - 90 minutes
Load – when ready
No free space
Rest 10 mints
Emergency trey
Easy IUI
9th secret
Luteal support
• Progesterone
• Vaginal progesterone (↑ PR) is the BEST
10th secret
Counseling / Knowing when to stop
3 cycles of IUI = 1 IVF
Final secret
All that we are
• Integrity of Team
• Right documentation
• Analysis of Result what works
Thanks