Intrauterine Insemination Treatment

1
(No Transcript)
2
Intrauterine Insemination (IUI) is the
therapeutic introduction of sperms in the
uterine cavity
3
Function of the Cervix -Cervical
Secretions -Physiological Filter -Capacitation
Stores
4
Carrying out the Cervical Function in the
Laboratory - getting rid of debris, abnormal
sperms, seminal plasma - picking up good motile
sperms - invitro capacitation
5
Indications -Cervical Infertility -Male
Infertility Oligoasthenozoospermia Azoospermia Ret
rograde Ejaculation Husband living abroad for
long stretches of time -Donor Insemination -Unexpl
ained Infertility -Immunological
Infertility -Mild Endometriosis -Allergy to
Seminal Plasma
6
Contraindications -Unhealthy Tubes -Acute Genital
Infection -Hyperstimulated Ovaries -Medical/Psycho
logical/Social
7
Sample Collection -Masturbation -Split
Ejaculate -Viscous Sample -Pooled Ejaculates
8
Rotunda - The Center For Human Reproduction -Swim-
up using Medicult Flushing Medium -Density
Gradient Separation using Medicult SupraSperm
9
Buffer Systems pH Most Media Utilize The
Physiological Bicarbonate/CO2 buffer system to
maintain a physiological pH of around 7.4 in the
medium.
10
-Preparation Methods Without Centrifugation Will
Be Preferred -Reactive Oxidative Stress Induced
By Reactive Oxygen Species (ROS) Such As
Hydrogen Peroxide Super Oxide Anion -ROS Affect
The Unsaturated Fatty Acids On The Plasma
Membrane Of The Spermatozoon
11
Techniques of IUI
12
The Volume of the Inseminate The Type of
Insemination Type of Catheter used for
Insemination
13
(No Transcript)
14
The Type of Insemination Bolus Technique Pulsatile
Intrauterine Insemination Slow Release
Intrauterine Insemination
15
Why Slow Release? SRIUI More Physiological SRIUI
may induce local PGs which may improve sperm
transport BoIUI may have an adverse immunological
impact BoI may cause polyspermia
16
Type of Catheter used for Insemination Atraumatic
Embryo Transfer is Essential for Successful
Implantation -Leeton J, Trounson A, Jessup D,
Wood C. The technique for human embryo transfer.
Fertil Steril 198238156-161. Wood C, McMaster
R, Rennie G, Trounson A, Leeton J. Factors
influencing pregnancy rates following IVF-ET.
Fertil Steril 198543245-247. -Englert Y,
Puissant F, Canus M. Clinical study on embryo
transfer after human IVF. J In Vitro Fertil
Embryo Transfer 19863243-246. -Diedrich K, van
der Ven H, Al-Hasani S, Krebs D. Establishment of
pregnancy related to embryo transfer techniques
after IVF. Hum Reprod 1989 4 (Suppl) 111-114.
17
(No Transcript)
18
Timing of IUI
19
After insemination, cryopreserved semen retains
its fertilizing capacity no longer than 24 hours.
Thus, it is very important to time your
inseminations well.
20
Two Inseminations before after ovulation
resulted in a higher PR when compared with a
single insemination. Silverberg et al. Fertility
Sterility 199257357-361
21
Duration of Treatment
22
OI with gonadotropins IUI compared with IVF
no therapy a prospective nonrandomized, cohort
study and meta-analysis Peterson et al.
Fertil-Steril 199462(3)535-44. Cost-benefit
analysis comparing hMG IUI, IVF, no therapy
in infertility patients may favor a course of
four cycles of hMG and IUI as the first line of
therapy. Using meta-analysis theoretical
assumptions, the PR for one cycle of hMG IUI is
inferior to IVF, GIFT, or ZIFT two cycles are
comparable to IVF or ZIFT inferior to GIFT 3
cycles are superior to IVF or ZIFT and comparable
to GIFT and four cycles are theoretically
superior to all techniques.
23
Reasons for the high PRs with Superovulation
IUI -Superovulation corrects subtle ovulatory
disorders - Superovulation increases the number
of preovulatory follicles -Increase in ovarian
size may bring the ovary in close proximity to
the fimbria - Superovulation may affect tubal
vascularity to enhance ovum pickup
mechanisms -Swim up techniques enhance
fertilizing capacity of sperms -IUI increases the
number of sperms reaching the Ampullo-Isthmic
Junction
24
Predicting optimizing success in an IUI
program Fluker SM et al. Hum-Reprod
19949(11)2014-2021 IUI is not beneficial to
women gt40 years old, and has the best chance of
success within three cycles. Multiple follicle
recruitment using hMG based protocols and
midcycle hCG are necessary to achieve an
acceptable PR.
25
Results
26
June 97-May 98 Indications No. of Pts.
No. of Ins. Pregnancies Abortions Unexplaine
d 48 110
12(25) 5 Tubal Factor 10
27 2(20)
1 Anovulation 29 54
4(13.8) 1 Endometriosis
1 2 -
- Immunological 2
3 -
- Male Factor 36
78 4(11.1) 2 Multiple
Factors 10 41
1(10) - Donors
22 119 6(27.3)
- Total 158 434 29(18.35)
9
27
Does IUI offer an advantage to cervical cap
insemination in a donor insemination
program? Williams DB et al. Fertil-Steril
199563(2)295-98
28
Value of sperm morphology assessed by strict
criteria for prediction of the outcome of
IUI Toner JP et al. Andrologia
199527(3)143-48
29
A comparision of IUI in superovulated cycles to
intercourse in couples where the male is
receiving steroids for the treatment of
autoimmune infertility Robinson JN et al.
Fertil-Steril 199563(6)1260-1266
30
Complications
31
Pregnancy after IUI with Sperm retrieved from the
rectum Gleicher N et al. Fertil-Steril
199467(3)554-555
32
A randomized prospective comparision between IUI
FSP for the treatment of Infertility Karande VC
et al. Fertil-Steril 199564(3)638-40. The
overall PRs per cycle (10.8 versus 10.2) were
similar for IUI and FSP respectively. The PRs
were also similar when compared for ovulation
induction with CC (6.8 versus 9.1) and
gonadotropins (13.2 versus 11.8).
33
Fallopian Tube Sperm Perfusion Until we have
evaluated the procedure of FSP using the
principles of Evidence Based Reproductive
Medicine13, we should not designate FSP as one of
the milestones of reproductive medicine as has
been attempted by certain groups. Desai SK,
Allahbadia GN. Middle East Fertility Society
Journal 4(2)173-1741999.
34
Gamete Intrauterine Transfer Lens S et al.
Baillieres-Clin-Obstet-Gynaecol
19926(2)339-49
35
(No Transcript)