JaypeeDigital | eBook Reader

IUI: Intrauterine Insemination Gita Ganguly Mukherjee, BN Chakravarty

SECTION 1: GENERAL
1:Intrauterine Insemination — An Overview
- Introduction
- Terminology
- Rationale of IUI
- Indications of IUI
- Natural Versus Stimulated Cycle IUI
- Procedure of IUI
- Luteal Phase Support
- Success Rates of IUI
- Factors Affecting IUI Success Rates
- Complications of IUI
- Cost-effectiveness of IUI
- IUI in HIV Discordant Couples
- Ethical and Legal Issues in IUI
- Future Challenges
- Conclusion
2:Physiology of Ovulation with Special Reference to Controlled Ovarian Hyperstimulation
- Introduction
- Gonadotropin Dependent Follicular Development
- Steroidogenesis Two-Cell, Two-Gonadotropin System
- Conclusion
3:Physiological Aspect of Semen and Sperm with Special Reference to Intrauterine Insemination
- Introduction
- Composition of Semen
- Concept of Sperm Washing in IUI, Physiological Point of View
- Anatomy of Normal Mature Sperm (Fig. 3.1)
- Unique Characteristics of Human Spermatozoa
- Functions of Sperm and Intrauterine Insemination
- Selection of Sperms
- Transport of Sperm (Motility)
- Capacitation
- Sperm physiology, Reactive Oxygen Species and Intrauterine insemination
- How to Protect Sperm Damage during Semen Preparation?
- Use of Sperm Vitalizing Agent with Media and Sperm Function
- Conclusion
4:Indications and Selection Criteria in an Intrauterine Insemination Program
- Artificial Insemination with Husband's Sperm (AIH)
  - Indications
- Donor Insemination
  - Indications
- Pre-requisites
  - Basic Investigations Before Starting the IUI Cycle
- Selection Criteria
- Conclusion
5:Role of Laparoscopy before Intrauterine Insemination
- Introduction
- Conclusion
6:Counseling in Intrauterine Insemination Program
- Introduction
  - Psychology of Infertility
- Goals of Counselor
  - Characteristics of Counseling
  - Methods of Counseling
- Intrauterine Insemination
  - General Counseling for IUI
  - Specific Counseling for IUI
- Psychological Evaluation and Management
- Counseling for Donor Insemination
- Coping with Failure
- Information and Counseling to be given to the Patients
- Word of Caution
7:Setting up a Clinic and Laboratory in Intrauterine Insemination Program
- IUI in Various Scenarios
- Registration and Accreditation
- Location of the IUI Clinic—Basic Requirements
  - Building Design
  - Facilities Required
- IUI Clinic—Overall Design
- Laboratory Design
- Facilities
- Consumables
  - Media
  - Ultrasound Scanning
- Record Maintenance
- Health and Safety
- Conclusion
SECTION 2: ANDROLOGY
8:Semen Analysis According to WHO Criteria
- Introduction
- Semen Analysis Criteria and the Reference Values
- Ejaculate Volume and pH
- Criticism on Revised Parameters of 5th WHO Manual
9:Semen Collection
- Introduction
  - Normal Scenario
  - Home Collection
- Special Circumstances
  - Ejaculatory Dysfunction
  - Remedial Measures
- Mechanical or Electrical Procedure
- Conclusion
10:Semen Preparation for Intrauterine Insemination
- Introduction
- Criteria before Semen Preparation
- Essentials for Semen Preparation
- Conventional Methods
- Modified Methods
- Semen Preparation in Special Circumstances
- Conclusion
  - Future Scope for Improvement
11:IUI in Male Subfertility: How it Affects Outcome of IUI?
- Examination of Semen
  - Management of Male Infertility: Oehninger
  - Latest WHO Sperm Analysis
- Identification and Clinical Management of Male Infertility
- Definition of Male Subfertility
- Discussion
- Summary
- Implications for Practice
- Acknowledgment
12:Semen Freezing and Use in Intrauterine Insemination
- Introduction
- Background of Sperm Banking
- Principles of Cryobiology
  - Changes in Volume of Sperm when Exposed to Cryoprotectants
- Indications of Semen Cryopreservation
- Sample Collection
- Physiology of Semen Cryopreservation
- Overview of Semen Banking—Step-by-Step
- Recovery of Spermatozoa Post-thaw
- Donor Screening Prior to Semen Banking
- Crossinfection in the Semen Banks
- Security of the Semen Bank
- Future of Semen Cryopreservation
- Emerging Role of Semen Banking on Onco-ART
- Legislation Pertaining to the Semen Banking
- Conclusion
SECTION 3: OVULATION
13:Ovarian Stimulation for Intrauterine Insemination—An Introduction
- Introduction
  - Natural Cycle IUI
    - Advantages
    - Disadvantages
- Oral Ovulation Induction Drugs
- Conclusion
14:Natural Cycle Intrauterine Insemination
- Introduction
- What is Natural Cycle IUI?
- Conclusion
15:Clomiphene/Letrozole Stimulation in Intrauterine Insemination
- Introduction
- Clomiphene Citrate
- Letrozole
- Conclusion
16:Gonadotropin Stimulation in Intrauterine Insemination
- Introduction
- Physiology of Ovulation and Central Role of Gonadotropins
- Classification of Ovulatory Disorders4
- Management of Anovulatory Infertility
  - Preparations
  - Recombinant vs Urinary FSH
- Different Treatment Regimes with Gonadotropins
- General Considerations
- Cycle Progression and Monitoring
- hCG Administration
- Overall Outcome of Gonadotropin Stimulation in IUI Cycles
  - Contraindications of Gonadotropins
- GnRH Agonist with Gonadotropins
17:GnRH Antagonists in Intrauterine Insemination
- Introduction
- Types of GnRH Antagonists
- The Mechanism of Action of GnRH Antagonists
- When to Use?
- Evidence for Use of GnRH Antagonists
- Our Experience
- Conclusion
18:Role of Adjuvants for Ovulation Induction in IUI Cycles
- Introduction
- Use of Adjuvants
- Conclusion
SECTION 4: SPECIAL SITUATIONS
19:Role of Intrauterine Insemination in Unexplained Infertility
- Introduction
- Management
- Outcomes of IUI Cycles
  - Conditions Affecting the Prognosis
- Conclusion
20:Intrauterine Insemination in Endometriosis
- Introduction
- Indications
- Minimal-to-Mild Endometriosis
- Moderate-to-Severe Endometriosis
- Conclusion
21:Intrauterine Insemination in Polycystic Ovary Syndrome
- Introduction
- Pathophysiological Considerations for IUI in PCOS
- Management—Essential Steps in Optimizing IUI Outcome in PCOS
- Outcome of Treatment—Results and Risks
- When to Move on—PCOS and Assisted Reproduction
- Conclusion
22:Human Immunodeficiency Virus and Intrauterine Inseminations
- Background
- Present Scenario
- A Brief Overview of HIV Infection and its Relevance in ART (Figs 22.1 and 22.2)
- Assisted Reproductive Technologies
- Pretreatment Preparations
- IUI or ICSI
- IUI–Sperm Preparation
- Influence of HIV Infection and HAART on Semen Quality
- Conclusion
SECTION 5: PROCEDURES
23:Monitoring in Intrauterine Insemination Cycle
- Introduction
- Monitoring of Response in Ovulatory Cycle
- Sign of Ovulation
- Anovulatory Ovary
- Color Doppler Study
- Endometrium in Menstrual Cycle
- Disparity between Follicular Growth and Endometrial Thickness
- Cervical Mucus Study
- Alternative Tests
- Serial Urinary LH Kit
- Serum E2 Estimation
- Serum LH and P4
- Timing of Ovulation Trigger (hCG or GnRH Agonist)
- Monitoring of Insemination
- Monitoring of Quality Control
- Monitoring of Complications
- Conclusion
24:IUI Techniques and Difficulties Faced During Insemination
- Introduction
- Intrauterine Insemination (Fig. 24.1)
- Difficulty Faced During Insemination
- Other Techniques of Intrauterine Insemination
  - Fallopian Tube Sperm Perfusion
  - Intrauterine Tuboperitoneal Insemination (IUTPI)
25:Role of Luteal Phase Support in IUI
- Introduction
- What is the Evidence for Luteal Support?
- Therapeutic Agents for Luteal Phase Support
- Discussion
- Conclusion
26:Complications of Intrauterine Insemination
- Introduction
- Complications
- Risks Associated with Ovulation Inducing Drugs
- Risks Associated with Procedure and Donor Sperm
- Pregnancy Related Complications
- Babies from IUI
- Psychological and Ethical Issues
  - Psychological and Emotional Complications
- Conclusion
27:Ethical and Legal Aspects of Intrauterine Insemination
- Introduction
- Artificial Insemination
- Indications for AIH and AID
- History of Artificial Insemination
- Ethical Aspects of Intrauterine Insemination
- Some of the Core Ethical Issues Faced by Couples, Individuals and Families
- Legal Issues
- Information and Counseling
- Consent
- ICMR Guidelines Concerning Artificial Insemination
- Artificial Insemination and Consummation of Marriage
- AID does not Amount to Adultery ART
- Legitimacy of a Child Born Through AID
- Right of an Unmarried Woman to AID
  - Posthumous AIH through a Sperm Bank
  - Donor Anonymity
- Conclusion and Suggestions
28:Guidelines in Intrauterine Insemination Program
- Introduction
- Process Indicators for IUI Care
- Structured Indicators for IUI Care
- Research Recommendations
- Indian Scenario
  - Intrauterine Insemination with Either Husband's or Donor Semen
- Categories of Infertility Care Units
- Conclusion
SECTION 6: RESULTS
29:Intrauterine Insemination: How to Make it Cost-effective?
- Introduction
- What is Cost-effective IUI?
- How to Make IUI Cost-effective?
- Conclusion
30:Pregnancy Outcome and Follow-up in IUI Cycles
- Is Pregnancy after IUI Considered High-risk?
  - Intrauterine Insemination Risks
- Pregnancy Outcome after IUI—A ‘PubMed’, ‘Medline’
- Follow-up in IUI Cycles
  - IUI Pregnancy Symptoms
- Conclusion
31:Why Intrauterine Insemination Fails?
- Introduction
- In vitro Semen Manipulation
- Selection of Patients
- Time of Insemination
- IUI Failure can happen due to Improper Egg Pick-up
- Poor Follicular Development as Well as Poor Oocyte Quality Hinders IUI Success
32:How to Improve the Success in Intrauterine Insemination Program?
- Introduction
- Optimizing Good Ovarian Response
- Age and IUI Success
- Influence of Semen Characteristics on IUI Outcome
  - Laboratory Manipulation to Improve Sperm Function
- Clinical Technique and IUI Success
- Conclusion
SECTION 7: IUI—INCEPTION AND FUTURE
33:The History of Artificial Insemination
- Introduction
- Early Experiments
  - Aquaculture (Water Farming)
  - Mammals
- Human Artificial Insemination
- Further Milestones in the History of Human Artificial Insemination
- Conclusion
34:Future Challenges in Intrauterine Insemination
- Improving the Success Rates
- Semen Preparation
- Avoidance of Third Party Involvement in Artificial Insemination
- Application of Stem Cell Culture in the Generation of Male and Female Gametes (Fig. 34.1)
- Practical Problem that may Arise from Preservation of Stem Cell
- Intrafallopian Insemination
- Conclusion

INDEX

TOC
Index

×

Chapter Notes