10 secrets of success of IUI Dr. Sharda Jain Programme Director

1st 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

• Age – women & men • Ovarian response (Poor /High/ Normal) • Endometrial Response• AMH

Understand The Case (H & W)

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 age - < 35 yrs > 45 yrs >10 million prewash count5-10 million Post Wash Count Normal morphology – 14% (Krugers)DNA fragmentation - 30 %Sperm survival (24 hours) - ↑ 80%

Male

3rd secret

• Typical PR 4 / 8 / 12 / 20• G T• Antagonist in IUI protocol

Individualised Ovarian Stimulation Protocol

4th secret

• CC – neg. effect on ET – EV ?• Delay trigger

• GT• Scratching of Endometrium • ↑ Endo Vascularity (Aspirin/ Viagra / Sidnafil)

Poor Endometrial Thickness

Modify Dose / ET / Follicle size / HCG Trigger - GT - EV

5th secret

Follicle Monitoring Do it your self

Trigger when GT – 17-18 mm CC -24 -25 mmDoppler – Perifollicular perfusion 50 – 70 % RI < 5 PSV > 11S/C HCG – (BMI)Agonist trigger - OHSS

6th secret

Do Right Thing at Right Time

Timing of IUI – 38 hoursSingle – 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

• 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

Lab secret

8th secret

• Full Bladder • Cx mucus aspiration • Targets time - 90 minutes• Load – when ready • No free space • Rest 10 mints • Emergency trey

Easy IUI

Success lies in looking into details of techniques

9th secret

• Progesterone • Vaginal progesterone (↑ PR) is the BEST

Luteal support

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