Role Of AMH In Infertility , Dr. Sharda Jain , Life Care Centre
10 secrets of success of IUI Dr. Sharda Jain Programme Director.
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Transcript of 10 secrets of success of IUI Dr. Sharda Jain Programme Director.
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