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 count
5-10 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 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
• 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