10 secrets of success of IUI

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10 secrets of success of IUI

• Dr. Sharda Jain
• Programme Director

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1st Secret

• Right choice based on facts
• 
  (Actiology)

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• Good Result - Unexplained I
• - Cervical Factor I
• - Anovulatory I
• - Donar IUI

Poor Results - severe male infertility
tubal factor/
pelvic
adhesions
severe endometriosis
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2nd secret
Understand The Case (H W)

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

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• Good Responders - young
• - Good Crop of
• Preovulatory
  follicles
• - Good ET
  (gt 7 mm)
• -
  Good PMS count

Poor Responders -
Older self / partner,
- ? duration infertility (gt 5 yrs)
- Poor OR
- Poor ET
- Poor Sperm Quality
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Male

• Male age - lt 35 yrs
• gt 45 yrs
• gt10 million prewash count
• 5-10 million Post Wash Count
• Normal morphology 14 (Krugers)
• DNA fragmentation - 30
• Sperm survival (24 hours) - ? 80

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3rd secret
Individualised Ovarian Stimulation Protocol

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

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4th secret
Poor Endometrial Thickness

• CC neg. effect on ET EV ?
• Delay trigger
• GT
• Scratching of Endometrium
• ? Endo Vascularity
• (Aspirin/ Viagra / Sidnafil)

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5th secret
Follicle Monitoring Do it your self

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

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6th secret
Do Right Thing at Right Time

• Trigger when
• GT 17-18 mm
• CC -24 -25 mm
• Doppler Perifollicular perfusion 50 70
• RI lt 5
• PSV gt 11
• S/C HCG (BMI)
• Agonist trigger - OHSS

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• Timing of IUI 38 hours
• Single No Male Factor
• Double IUI Male factor, PSV gt 20
• 1st 16 - 18 hrs
• 2nd 36 38 hrs

LH surge - Give HCG trigger immediately
- IUI 24 hrs
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7th secret
Lab secret

• Labeling
• Abstinance (lt3 V/S gt 10 days)
• Semen collection
• Semen preparation
• One size does not fit all
• High quality Consumables media

Preparation in doctors office must
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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
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9th secret
Luteal support

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

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10th secret

• Counseling / Knowing when to stop
• 3 cycles of IUI 1 IVF

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Final secret

• All that we are
• Integrity of Team
• Right documentation
• Analysis of Result what works

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Thanks