Intrauterine insemination. Aboubakr Elnashar

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  1. 1. Benha Univresity hospital Email: [email protected] In Portugal ABOUBAKR ELNASHAR
  2. 2. Direct transfer of processed semen into the uterine cavity about the time of ovulation 1. DEFINE ABOUBAKR ELNASHAR
  3. 3. 2. RATIONALE A. Direct transfer: 1. 3 of the natural barriers (vagina, cervical mucus, and cervix) that sperm have to traverse are bypassed. 2. More sperm are placed closer to the site of fertilization (fertilization occurs in the fallopian tube). B. Processed semen: 1. Washing organisms, prostaglandins& antibodies 2. Deposition of a bolus of concentrated, motile, morphologically normal spermABOUBAKR ELNASHAR
  4. 4. ADVANTAGES OF IUI 1. Non invasive (like pap smear). 2. Inexpensive. 3. Easy to perform 4. Training is easy 5. Risks are minimal 6. Antenatal & perinatal complications: like pregnancies from normal S I ABOUBAKR ELNASHAR
  5. 5. 3. INDICATIONS A.Male: I. Ejaculatory failure: Retrograde ejaculation Hypospadius Impotence Infrequent Intercourse during fertile period. ABOUBAKR ELNASHAR
  6. 6. II. Male subfertility: Mild Severe male infertility: Count 12 mm > 8 ABOUBAKR ELNASHAR
  7. 22. No evidence of a difference in LBR between hCG injection vs LH surge urinary hCG vs rec hCG or hCG vs GnRHa Optimum time interval from hCG injection to IUI: 24 h to 48 h. No difference in LBR Choice should be based on 1. hospital facilities, 2. convenience for the patient, medical staff, 3. costs and dropout levels [Cochrane SR , 2014]. ABOUBAKR ELNASHAR
  8. 23. Number of inseminations: One insemination performed 34-38 h after HCG or 24-36 h after urine LH surge The next day after HCG (Egyptian fertility center) 2 inseminations performed: 24 & 48 h after HCG. 12 & 34 h after HCG (Rangi et al,1999). ABOUBAKR ELNASHAR
  9. 24. V. SPERM PREPARATION 1. Swim up method 2. Density gradient centrifugation. (DGC) Collection of semen: 1. Sperm is obtained by masturbation into a sterile container after 3-5 days of sexual abstinence. 2. Avoidance of lubricants {most are toxic to sperm}. If a lubricant is needed, instruct the client to prevent contact between the lubricant and glans. ABOUBAKR ELNASHAR
  10. 25. Selection of the method: 1. Normozoospermia: Swim up {simple & quick way of producing a purified inseminate containing a high percentage of progressively motile spermatozoa}. 2. Sperm disorders: (OAT): DGC: superior to swim up technique. 3. High leukocyte concentration (>1x107/ml): Swim up from semen, DGC (sperm wash only after cell separation) ABOUBAKR ELNASHAR