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Pai’s Textbook of Intrauterine Insemination
Rishma Dhillon Pai, Nandita P Palshetkar, Hrishikesh D Pai
1:
Introduction to IUI
INTRODUCTION TO IUI
2:
Indications, Patient Selection and Work-up Before IUI
INDICATIONS OF IUI
Male Factors
Impotence/ejaculatory dysfunction
Retrograde Ejaculation
Subnormal Semen Parameters
Other Factors
Female Factors
Ovulatory Dysfunction
Cervical Factor
Endometriosis
Common Factors
Immunological
Unexplained Infertility
Insemination with Husband's Frozen Semen
Insemination with Donor Sperms
Patient Selection and Work-up
EVALUATION OF THE FEMALE PARTNER
Routine Investigations
Hormonal Investigations
Serum FSH, LH, estradiol on day 2/3 of cycle
Serum Prolactin and T3 /T4/ TSH
Tests for Ovulation (Ovulatory or Anovulatory)
Pelvic Sonography
Tests to rule out Tuberculosis
EVALUATION OF MALE PARTNER
PREREQUISITES FOR IUI
3:
Normal Semen Analysis and CASA
INSTRUCTIONS TO THE COUPLE
COLLECTION OF SPECIMEN
PHYSICAL PARAMETERS
Coagulation
Liquefaction
Appearance
Odor
Volume
Viscosity
pH
Normal Semen Parameters as Suggested by WHO
Initial Microscopic Examination
Agglutination and Aggregation
Other Cells and Debris
METHODS OF ASSESSMENT OF SPERM CONCENTRATION
Makler Chamber
Chamber Description
Advantages of using Makler Chamber
Hemocytometer
SPERM MOTILITY
Techniques for Evaluation of Sperm Motility
Manual Motility Estimates (Wet Mount)
SPERM MORPHOLOGY
FRUCTOSE LEVEL
RECENT ADVANCES IN SEMEN ANALYSIS
CASA
CASA Systems
4:
Setting up of an IUI Laboratory
REGISTRATION AND ACCREDITATION
Laboratory Design (Figs 4.2A and B)
Bench Space
Water
Air
EQUIPMENTS
Centrifuge (Figs 4.3A and B)
Incubator (Fig. 4.4)
Laminar Flow Hood
Microscope
Digital Heater (Fig. 4.7)
Sperm Counting Chamber
Refrigerator
MEDIA (Fig. 4.9)
RECORD MAINTENANCE
5:
Ovulation Induction in IUI
RATIONALE FOR INDUCING OVULATION WHILE CARRYING OUT IUI
OVARIAN STIMULATION OR INDUCTION
Ovulatory Patients (Ovarian Stimulation)
Anovulatory Patients (Ovarian Induction)
Tests Before Ovarian Stimulation
VARIOUS DRUGS COMMONLY USED FOR OVULATION INDUCTION
Clomiphene Citrate (CC)
Outcome After Clomiphene Citrate
Letrozole*
Letrozole and Ovulation Induction
Doses
Extended Letrozole Therapy
Letrozole Step-up Protocol
Gonadotropins
Choice of Gonadotropins
Factors Influencing the Dose of Gonadotropins
Regimens
Clomiphene Citrate with Gonadotropins
Disadvantage
Letrozole with Gonadotropins
GnRH Analogue in Combination with Gonadotropins
GnRH Antagonists
Advantages of Antagonist Protocol
6:
Monitoring in Intrauterine Insemination
MONITORING OF FOLLICULAR GROWTH AND ENDOMETRIAL DEVELOPMENT
Ultrasonographic Monitoring
Monitoring Follicular Growth
Assessing the Follicular Maturity
Predicting the Risk of OHSS and Multiple Births
Monitoring the Endometrium
Serial Serum Estradiol Levels
Detecting the LH Surge
Ovulation Trigger and Timing of Insemination
Case 1
Case 2
7:
Role of Doppler in Intrauterine Insemination
INTRODUCTION
Baseline Scan
Baseline Scan of Ovaries
Uterus
Preovulatory Scan
Application of 3D US for Follicular Assessment
Features of a Mature Endometrium
Endometrial Grading14 (Figs 7.9A to C)
On color Doppler, the vascularity of the endometrium is classified by Applebaum as follows (Figs 7.10A to D).15
Secretory Scan
Luteinized Unruptured Follicle
Luteal Phase Defect
8:
Semen Preparation Techniques for IUI
ADVANTAGES OF SEMEN PREPARATION
TYPES OF TECHNIQUES
Swim Up Technique (Figs 8.1A and B)
Overlay Method
Density Gradient Method
Other Techniques
Simple Wash
Glass Wool Filtration
Sperm Select Method
COMPARISON OF VARIOUS METHODS
PROBLEM SAMPLES
Viscous Samples
Excessive Pus Cells
Low Volume
Teratozoospermia
Antisperm Antibodies
HIV Infection
9:
Technique of Intrauterine Insemination
INTRAUTERINE INSEMINATION (IUI)
TIMING OF INSEMINATION
DETECTION OF LH SURGE
OVULATION AFTER hCG INJECTION
NUMBER OF INSEMINATIONS
SEMEN COLLECTION AND SAMPLE ASSESSMENT
SPERM PREPARATION
Choice of Insemination Cannula
Soft Artificial Insemination Catheters
Firm Artificial Insemination Catheters
LOADING THE IUI CATHETER (Fig. 9.8)
VOLUME OF INSEMINATION
PROCEDURE FOR IUI
Prerequisites
Method
Post IUI Instructions
10:
Luteal Phase Support in IUI
WHY LUTEAL SUPPORT IS NEEDED IN CONTROLLED OVARIAN STIMULATION WITH IUI?
TYPES OF PROGESTERONE
Natural Progesterone (Micronized Progesterone)
Other Progestogens
Dydrogesterone
DURATION OF SUPPORT
ROLE OF ANTIBIOTICS
Case
11:
Difficult IUI
ACUTELY ANTEVERTED/RETROVERTED UTERUS
STENOSED CERVIX
ABNORMAL CERVICAL CANAL
APPREHENSIVE PATIENT
ROLE OF SONOGRAPHY IN DIFFICULT SITUATIONS
12:
Complications of IUI
COMPLICATIONS DUE TO OVARIAN STIMULATION
Immediate
Delayed
Ovarian Hyperstimulation Syndrome (OHSS)
Incidence
Pathophysiology
Classification of OHSS
Complications of OHSS
Prediction
Prevention
Treatment
Mild OHSS
Indication of Hospitalization
Multiple Pregnancies
Risk of Ovarian Cancer
COMPLICATIONS DUE TO THE PROCEDURE
Infection
Prevention
Trauma and Bleeding
Pain
Noninfective Salpingitis
Allergic Reaction
Vasomotor Symptoms
Antisperm Antibody
OTHER COMPLICATIONS
Abortion
Ectopic Pregnancy
Accidental Wrong Samples
13:
Determinants of Success and Optimizing Success of IUI
FACTORS INFLUENCING PREGNANCY RATES WITH IUI
Laboratory Factors
General factors
Concomitant use of GnRH Agonists with Superovulation and IUI
Concomitant use of GnRH Antagonist with Superovulation and IUI
Male Factors
Common Factors
Duration of Infertility
Number of IUI Cycles
Number of Inseminations Per Cycle
Type of Catheter
Laboratory Factors
14:
Donor Insemination
INDICATIONS1
DONOR WORK-UP
Psychological Issues and Counseling1
Consent
Legal Aspects and ICMR Guidelines for Donor Insemination
Responsibilities of the Clinic
Confidentiality
Avoiding a Mixing of Semen Samples
Limitations to Donor Use
Record Keeping
Known Donor
Legal Issues in Marriage
15:
Sperm Cryopreservation
INDICATIONS OF CRYOPRESERVATION
PRINCIPLES OF CRYOPRESERVATION
Cryoprotectants
Cooling and Warming Rates
STEPS OF CRYOPRESERVATION
Noncontrolled Rate Cryopreservation (Liquid Nitrogen Vapor Cooling)
Controlled Rate Freezing
Thawing
INDEX
TOC
Index
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