panel iui by dr shashwat jani ( optimizing success in intrauterine insemination )

Download Panel IUI by DR SHASHWAT JANI ( Optimizing Success in Intrauterine Insemination )

Post on 15-Jun-2015



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2. What are Male and Female factors for IUI.? Indications for donor IUI? 2e- mail: 3. Retrograde Ejaculation Impotence or Ejaculatory Dysfunction Hypospadias Hypospermia (Low Volume) Non Liquefying / highly viscous semen Subnormal semen parameters Seminal Antisperm Antibody Unexplained Infertility. 3e- mail: 4. Vaginismus Cervical Hostility Ovulatory Dysfunction Mild Endometriosis Allergy to seminal plasma Unexplained infertility 4e- mail: 5. Azoospermia with testicular failure Severely abnormal semen parameters Use Discretion) Hereditary disease in man Severe untreatable Rh isoimmunisation in wife Repeated failures with IVF/ICSI Single women, lesbian couples (Use Discretion) 5e- mail: 6. Spontaneous. Clomiphene Clomiphene + Gonadotrophins Gonadotrophins. What are the Standard Protocols??? 6e- mail: 7. Gonadotropins only Gonadotropins with CC Gonadotropins with GnRH analogs Gonadotrophins with GnRH antagonists 7e- mail: 8. Standard protocol Most commonly used Started from day 3,4,5 Daily or alternate days 75 to 150 IU / day till hCG 8e- mail: 9. Direct action Dose dependent response Fine-tuning of dose possible No unwanted side effect Like - Ant estrogenic effect of CC risk of abortion with CC in LH with CC E2 at hCG as seen with Letrozole 9e- mail: 10. Consumption Vs. CC / Letrozole + gonadotropins OHSS Multiple pregnancy Cost Injections only 10e- mail: 11. Protocols : - CC followed by gonadotropins - CC + gonadotropins from day 3 Dose : CC 50 100 mg. / day for five days + 75 to 150 IU / day - Daily or alternate days Adv. - less dose Disadv. - Anti-estrogenic effect of CC - Poor control 11e- mail: 12. Hypogonadotropic hypogonadism HMG is better as LH is required Patients with high LH A few PCO - FSH is better Gonadotropins are must for stimulation in down regulated patients Adequate LH is required 12e- mail: 13. Adv. : Effective Can prevent LH surge Choice of protocols Dis. adv. : Additional medication Gonadotrophin dose Cycle cost Length of treatment 13e- mail: 14. Occupy pituitary GnRH receptors Direct & immediate effect No flare response Immediate reversal Constant supply is must 14e- mail: 15. Adv.: - ? Gonadotropin requirement - ? Duration of treatment - Can use GnRH agonist for LH surge - CC/ Letroze can be used Disadv.: - Cost 15e- mail: 16. What are the Standard Sperm Preparation Techniques? Effect of Sperm count in success of IUI. 16e- mail: 17. Remove : Seminal plasma and debris Pus cells, RBCs Prostaglandins Antigens Separate best motile and morphologically normal sperm. Achieve Capacitation 17e- mail: 18. 1 ) Swim up technique : Advantage : Recovery of best motile sperm Disadvantage : Loose many motile sperm 2 ) Density gradient technique: Advantage: Maximum sperm recovered Disadvantage: A few non motile - dead sperm 18e- mail: 19. Severe Male infertility < 5 million Moderate Male infertility 35 years : Maximum 3 cycles then go for IVF!!!??? 31e- mail: 32. What success rate for IUI can be quoted ? Limitations of IUI ? Why IUI fails.? 32e- mail: 33. 1. It depends on case selection indication, wifes age, motile sperm count, media & method used & ease of catheter passage at insemination. EVERYTHING MATTERS. 2. Success rate does not exceed natural fecundity rate. Good units quote a success rate from 10% to 20% per cycle. 33e- mail: 34. 3. At this rate it may touch 60% at end of 5-6 months & does not increase thereafter. So if 6 good cycles & good inseminations have not worked then review the diagnosis 7 indication. 4. Success in natural cycle can be as low as 5% success with Clomiphene/Letrozole climbs upto 7-10%. Adding HMG/FSH along with Clomiphene can take success rate upto 20% per cycle. Combination of oral medication with HMG does not lessen success rate but cuts down total cost of HMG/FSH. 34e- mail: 35. Poor semen preparation Poor selection of patients Improper egg pick-up by fimbria due to peritubal adhesions Prevalence of empty follicle syndrome Or poor Oocyte quality. 35e- mail: 36. Hospital and lab distance. Proper maintenance of standard of Lab. Sperm requirement in millions Fertilization can not be assured Quality of embryo unknown 36e- mail: 37. e- mail: 37