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

Understand The Case (H & W) 2nd secret Understand The Case (H & W) Age – women & men Ovarian response (Poor /High/ Normal) Endometrial Response AMH

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 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%

Individualised Ovarian Stimulation Protocol 3rd secret Individualised Ovarian Stimulation Protocol Typical PR 4 / 8 / 12 / 20 G T Antagonist in IUI protocol

Poor Endometrial Thickness 4th secret Poor Endometrial Thickness CC – neg. effect on ET – EV ? Delay trigger GT Scratching of Endometrium ↑ Endo Vascularity (Aspirin/ Viagra / Sidnafil)

Follicle Monitoring Do it your self 5th secret Follicle Monitoring Do it your self Modify Dose / ET / Follicle size / HCG Trigger - GT - EV

Do Right Thing at Right Time 6th secret Do Right Thing at Right Time Trigger when GT – 17-18 mm CC -24 -25 mm Doppler – Perifollicular perfusion 50 – 70 % RI < 5 PSV > 11 S/C HCG – (BMI) Agonist trigger - OHSS

+ LH surge - Give HCG trigger immediately 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

Lab secret 7th secret Labeling Preparation in doctor’s office must 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

Success lies in looking into details of techniques 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

9th secret Luteal support Progesterone Vaginal progesterone (↑ PR) is the BEST

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