• Blood tests LH and prolactin are checked on D2 of the cycle. Based on that reports.
• Clomiphene alone is given or in combination with HMG injections / HMG injection can be given alone.
• Ultrasound is done to study the follicular growth and Dopper to study blood flow to follicles and endometrium.
• Dose of injection are adjusted according to the size of follicles and thickness of endometrium.
• HCG the last injection for rupture of follicle is given when follicle size is roughly 19-20mm.
• Natural intercourse is advised for 2 cycles.
• If not pregnant IUI is advised.
• Rest for 30 minutes after IUI.
• Normal life from next day.
• Intercourse next day after IUI.
• Normally bleeding does not occur but slight spotting may be there occasionally.
• To start Tab.Projesterone on the day specified. Insert the capsule inside the vagina morning and evening. Take 30 minutes rest after insertion.
• The capsule will dissolve and there may be discharge of medicine.
• If there is pain paracetamol( crocin) can be taken.
• You can resume normal activities the next day.
• Diet and bath normally.
• Avoid heavy work and travel on bad roads.
• Continue Folic acid and Aspirin and other medicines prescribed till the pregnancy test is done.
• Do a urine pregnancy test the day after progesterone gets over.
• If positive come to the hospital the sameday. If it gets delayed by 1-2days continue projesterone without fail.
• If negative wait for periods which will start within 5 – 7 days.
• Come to the hospital on 2nd day of periods for blood test ( LH and prolactin ) and further treatment.
Intrauterine insemination (IUI) It is a procedure in which sperms are “processed” and placed into the uterus through a fine catheter. The male partner produces a semen sample by masturbation. The sperms are separated from the seminal plasma, white blood cells, prostaglandins, and other “debris” which are normally filtered out during natural intercourse. A speculum is inserted into the woman’s vagina and a catheter with an attached syringe, containing the washed sperm, is inserted through the cervix into the uterus. The processed semen is placed in the uterus with a catheter very slowly.
• Women with Ovulatory dysfunction.
• Treated endometriosis with patent (Open )tubes.
• Luteal Phase Defects.
• Cervical Factor infertility.
• Polycystic Ovarian Disease can also try IUI before moving to advanced techniques.
• Men with slightly compromised semen parameters can also benefit by this procedure.
Sperm is normally collected in an exclusive semen collection room which is a very cozy private room with magazines and videos to assist collection of semen. Sometimes men can only collect with intercourse which is also possible using a special non lubricated condom. If the patient is unable to collect in the hospital he can collect it at home and hand over the sample to the lab within 40 min of collection. The container should be kept close to the body and should be maintained at body temperature (37degree C) as far as possible.
Normally collection is advised 3 – 5 days after abstaining from intercourse.
The IUI – High quality Semen preparation Process. Highly motile and morphologically normal sperms are separated by density gradient separation technique from the semen collected from the male partner.
The Separated good sperms are “washed and enriched” with special medium using high quality techniques under sterile conditions. These sperms are used for IUI. Preparation takes approximately an hour. Insemination should occur shortly after the sperm has been prepared ideally 15 – 20 minutes.
It takes a couple of minutes (1-2 minutes to introduce the catheter, then sperm injection, and another 2 min to remove the catheter ( slow insemination reduces discomfort ).
It can cause some discomfort, mainly when the catheter is passed through the cervix but usually it is painless.
At PFRC we use exclusive media and CO2 incubators for preparation of semen. We measure hormones and do Dopplers to make our success rates 25 – 30 %.
Very safe. Only when more follicles are produced, discomfort may be there but can be safely managed with medications.
If one IUI is done it is best done after follicles rupture. If 2 IUI’s are done one is 24 hrs after HCG injection and one after rupture. Scans are done every day and post HCG injection morning and evening to identify follicular rupture. With 2 IUI’s Pregnancy rates are 4 – 6% better. If LH is also measured then the IUI can be timed even more precisely and pregnancy rate is 3 – 4 % better. The life of an egg is 24 hours and sperm is 48hrs.
Hand wash with plain non medicated soap and wash the private parts. Open the container and collect the whole sample in a hygienic manner. Don’t spill the sample. If you spill, inform the lab.
1. Ideal Sperm count is 10 million post wash.
2. 5-10 million average
3. < 5 million the pregnancy rates are less.
4. One or 2 follicles are ideal.
5. Rupture of follicles should ideally happen on D14 – 15, 36- 48hrs after HCG injection but it may also happen latter.
6. Endometrium ( lining of the uterus ) should be 8 mm triple line pattern with a good zone 3 blood flow on Doppler.
• Cramping pain.
• Minor injury to the cervix.
• Introduction of infection.