IUI Protocols of Clinic Nirvana

Indications

• Mild male factor sub fertility
• Anovulatory cycles
• Unexplained sub fertility

Principle of Action

By stimulating the ovary with Low dose Gonadotrophin ,the idea is to get one or two good quality egg for ovulation.By semen washing the more motile sperm is separated from rest of the fluid and debris and is released as close to the Ovum as possible bypassing the cevical mucus which at times might be hostile to the sperm .

Pre requisite

Decent AMH

sperm count -atleast 5 million

Atlaeast1 patent fallopian tube ( Advisable to have IUI in the cycle in which there ovulation is happening from the side of open tube)

Sexually transmitted diseases have been ruled out or treated

Success rate

With clomiphene citrate or Letrozole – 6 to 10 % per cycle

With Gonadotrophins -18 to 20 % per cycle

IVF -30 to 35 % per cycle

Before IUI cycle

Blood work of both the partners -Hormonal profile,Pre conceptional tests ( within 3 months of treatment cycle)

Partners semen analysis ( after 3 days of abstinence-neither sex nor masturbation)

Tubal potency test – HSG,Laparoscopy,Hycosy,Sonosalpingogram

Procure medication from the clinic and understand the usage and protocol with possible side effects)

Procedure

Due to increased success rate I prefer to use Gonadotrophins for stimulation.Usual dose is 50 to 75 units of recombinant FSH for 5 days starting from day 2 of the periods.Serum estradiol and Ultrasound scan is advised the same day to rule out any functional ovarian cyst from previous cycle.

from day 6th of the stimulation follicle tracking by ultrasound scan is done at the clinic and decided if further FSH is needed or not.Once the dominant follicle reaches a size of 18 to 20 mm,HCG injection is administered.36 to 48 hours after HCG injection Ovulation is expected and IUI is timed accordingly. One needs to sign a detailed consent form prior to the procedure.

The partner is supposed not to ejaculate semen 48 hours prior to the procedure.On the day of procedure,Husband is supposed to give semen sample by masturbation at the andrology lab which takes almost 45 minutes in processing it.Once processed,semen is loaded in a IUI syringe and semen is put inside the uterus of the lady.IUI isn’t a painful procedure ,done without anaesthesia and at worst can be called uncomfortable.

The lady would need to lie down for 30 minutes post procedure and is advised a Progesterone supplement for 2 weeks .Incase of a missed cycle serum Beta HCG is recommended to confirm pregnancy.A total of 3 to 6 IUI cycles are recommended.The next step after which is IVF.

Very rarely incase of hyper stimulation where there is possibility of multiple pregnancy,the IUI cycle can be converted to IVF cycle.

Complications

Minimal chance of Hyperstimulation of Ovary

Multiple Pregnancy

Side effect of drugs ( separate leaflet provided)