SlideShare une entreprise Scribd logo
1  sur  46
At
Certificate Course
IUI & Stimulation
Faculty
• Dr. Sharda Jain
Prog. Director , Course Chair
• Dr Jyoti Agarwal
Director Courses Co- Chair
• Dr. Aruna saxena
Director Courses Co- Chair
• Dr. Jyoti Bhaskar
Director
• Dr. Abhishek Singh Parihar
Director
• Dr. Sushma Ved
Director
DR .ABHISHEK SINGH PARIHARDR .ABHISHEK SINGH PARIHAR
• FELLOWSHIP IN REPRODUCTIVE MEDICINE & IVF, CRAFT Hospital,Cochin
• Ultrasound training from Craft hospital, Cochin, Kerala
and Institute of Ultrasound Training, Delhi
• MS Obs & Gyne, RGUHS Bangalore (2008)
• MBBS Pondicherry University (2003)
AREAS OF CLINICAL INTEREST
• Reproductive Medicine, IVF, Andrology
Member :
• Federation of Obstetrics and Gynecological societies of India (FOGSI)
• Ghaziabad Obsterics and Gynecological society
• Gynecological Endocrine Society of India (GESI)
• Indian Medical Association (IMA), Ghaziabad branch
• Delhi Gynecologist’s Forum (DGF)
• Indian Fertility Society (IFS)
Invited as guest speaker at various societies & Conferences
Executive member, Ghaziabad Obs & Gynec Society
DR. ABHISHEK SINGH PARIHAR
M.S.( OBS & GYNAE), FELLOW REPRODUCTIVE MEDICINE.
CONSULTANT : Life care IVF Center, New Delhi
Abalone Clinic, Maternity & Fertility Center,
NOIDA
• Infertility is defined classically as
the inability to conceive after 1
year of unprotected and regular
intercourse. This definition is
based on the cumulative
probability of pregnancy.
1 iui a z, including techniques of iui & lps Dr. Sharda jain & Team
1 iui a z, including techniques of iui & lps Dr. Sharda jain & Team
• IUI places sperm directly into the uterus and
therefore close to any egg(s).
• Less stressful, LESS invasive and expensive
than IVF and similar procedures. It is therefore
often used when a male partner is subfertile, or
when the reason for not becoming pregnant is
unknown.
• Oldest assisted reproductive technique
• Most widely used worldwide
• A I techniques were first investigated in the
17th
century, as a treatment for infertility related
to male sexual dysfunction (e.g. the inability to
ejaculate).
• Dutch scientists first reported conception
following artificial insemination in 1742, when they
successfully fertilised the eggs of fish, by
artificially inseminating female fish with fish sperm.
• Human insemination began in the late
18th
century
• Instrument called the Fecondateur, a syringe to
assist insemination, was developed in 1866.
As a technique:
•Direct intrauterine insemination (neat semen)
- Disadvantage:
- PG cramps
- Infection.
•Split ejaculate
•The advances in IVF, ET. reviving IUI.
History of IUI
Abandoned
(Stone et
al, 1986)
Advances in:-
• Progress in semen processing and sperm isolation
methods.
• Improved ovarian stimulation protocols (developed
primarily to meet IVF requirements) →↓ ↓side
effects.
IUI progress is due to
advances in IVF, ET.
Reviving the interest in IUI
+
Advantages of IUIAdvantages of IUI
•Bypass ( Vaginal acidity + cervical mucus
hostility)
•Deposition of a well prepared sperms as close as
possible to the oocytes (Short distance)
•Non invasive
•Inexpensive.
•Antenatal & perinatal complications ( similar to
pregnancies from normal S I)
• Patient selection and work-up
• Ovarian stimulation
• Monitoring of follicular growth and
endometrial development
• Timing of insemination
• Number of inseminations
• Semen preparation
• Insemination procedure
• Luteal support
 Age < 40 years
 Patient capable of spontaneous or induced
ovulation
 Atleast one patent fallopian tube with good
tubo- ovarian relationship
 Sperm count of more than 10 million/ml pre-
wash or a post-wash count of >3-5 million
motile sperms with percentage motility of
more than 40%
 Easy access to the uterine cavity via a
negotiable cervical canal
Controlled ovarian stimulation
along with intrauterine
insemination –effective form of
treatment - select group of couples.
• Male factor
• Female factor
• Subnormal semen parameters
Oligozoospermia, Asthenozoospermia,
Teratozoospermia, Hypospermia, Highly viscous
semen
• Retrograde ejaculation.
• Ejaculatory failure-
• Anatomical
• Neurological
• Psychological
• Drug induced
• Unexplained infertility
• Cervical factor ( Cervical mucus hostility,
poor cervical mucus ) , Antisperm antibodies
• Ovulatory dysfunction (ovulating but no
pregnancy and associated with male factor-
ESHRE/ASRM)
• Minimal to mild endometriosis
• Vaginismus
• Allergy to seminal plasma
• HIV serodiscordant couples
• Absentee husband
• Anti – neoplastic treatment
• Vasectomy
• Poor semen parameters
• Drug therapy
• Severe abnormal semen parameters ( OAT ).
• Azoospermia ( OA – CBAVD, NOA)
• Hereditary disease in male partner.
• Repeated failure at IVF/ICSI.
• Infectious disease in male partner( HIV).
• Severe Rh incompatibility
• Single Women
• Tubal pathology
• Genital tract infection
• Severe male factor infertility
• Severe endometriosis
• Genetic abnormality in husband
• Unexplained genital tract bleeding
• Older women more than 40 years
• Multiple failures at IUI
• Oral drugs
• Oral drugs with gonadotropins
• Gonadotropins alone
• Gonadotropins with Gnrh analogs
• Gonadotropins with Gnrh antagonists
• Anovulatory women –
Monofolliculogenesis.
• Ovulatory women – Super ovulation
to increase the chance of pregnancy as
more eggs will be available for the
sperms to fertilize.
• Maximizes conception- ideally
expressed as singleton live birth at term.
• Minimizes multiple pregnancy and OHSS.
• Avoiding risks of preterm delivery,
perinatal morbidity and mortality to the
neonate and risks to the mother from
OHSS
• HCG
• Gnrh AGONIST
• Recombinant HCG.
• Routine administration of HCG adds little
to improving conception rates .Indicated
only when absent or delayed ovulation or
for timing IUI or intercourse.
(Fertil steril 2007)
1 iui a z, including techniques of iui & lps Dr. Sharda jain & Team
• Standard sperm wash
• Swim up
• Swim down method
• Density gradient
• Remove PG’s- cause uterine cramping.
• Semen mixed with buffered solution with
human serum albumin.
• Advanced preparation -selects motile &
superior quality sperm.
• Dead/ immotile/abnormal sperms- produce
10-15 times more Reactive oxygen species
than motile sperms.
• High level of ROS – reduces fertilization
 Threshold
 Pre wash
 Total count- 10 million
 Motility -30 %
 Total motile forms-
5 million
 Morphology - 5%
 8% VS 2.5% Pregnancy
rate per cycle
 Post wash
 4 – 5 million
 50 %
 Single IUI.
 36 hrs after HCG .
 After follicle rupture .
 Within 24 hrs of LH surge.
 Double IUI.
 At 24 and 48hrs after HCG adminstration.
 Day 6 and day 8 of last pill .
 NO statistical difference in pregnancy rates in
different timing regimens.
(Esra et al –Fert ster 2009)
• RATIONALE- increase opportunity for longer
fertilization period (22-47hrs).
• No clear benefit in terms of LBR.
(TafunBagis etal - Human Rep ,May 2010)
• Systematic review of 3 RCT- No difference.
(NICE guideline-fertility-2004)
• No clear benefit in terms of pregnancy rates.
(Meta analysis-Nikalaos-Fert stert Aug.2009.)
• Pre- ovulatory USG.
Fresh unwashed semen - 6-8 hrs before
ovulation.
Washed semen – No sooner than 4 hrs after
ovulation.
Cryopreserved semen – As close to
ovulation.
• LH testing kit.
Within 24 hrs of color change .
• Intra vaginal insemination
• Intra cervical insemination
• Intra uterine insemination
• Intra uterine tuboperitoneal insemination
• Direct intra peritoneal insemination
• Fallopian tube perfusion .
1 iui a z, including techniques of iui & lps Dr. Sharda jain & Team
• The patient is positioned .
• Cervix exposed with cuscos bivalve
speculum, excessive vaginal secretions are
wiped away and the cervical os is cleansed
with the standard buffer solution using a
cotton swab.
• IUI cannula is flushed with 1-2 ml of flushing
media to wash away any toxic factors
present.
• Specimen ( 0.4- 0.5ml) drawn into the catheter
and syringe.
• The catheter is gently introduced into the cervix
to pass beyond cervical os until the catheter
enters the uterus.
• The catheter is advanced to a depth of at least
4cm but no more than 6cm to avoid trauma to
the endometrium
• When the catheter is in place and before
ejecting the specimen , the opened forceps is
positioned on either side of the cervix and the
opposing ends gently squeezed together with
just enough pressure to prevent fluid escaping .
• The specimen is slowly ejected from the
syringe.
• The air remaining in the syringe is
expressed as the catheter is withdrawn, to
form an air block in the cervix.
• Pressure on the forceps should be
maintained until the cramping subsides,
usually within one minute
15 min of bed rest after IUI has shown to
improve ongoing pregnancy and LBR
(RCT-Custers etal BMJ2009).
• Luteal support in IVF cycles is associated
with increased pregnancy rates
• Luteal support is necessary when Gnrh
agonist,hcg and antagonist is used.
• Luteal support in the form of various forms
of progesterone and HCG can be given
depending on the clinical situation.
• Oral dydrogesterone 10 mg BD from day
of IUI.
• Micronized progesterone 100 mg BD
vaginally.
• Inj. Hcg 3000 iu i.m. once every 3days.
• Role of estradiol is not clearly defined.
• 08 -14% per cycle for all causes of infertility.
• Semen parameters- Count , Motility and
Morphology
(Van et al—Fert & Ster 2001)
(Lee et al –Int.J.Andr,2002)
Factors affecting success ofFactors affecting success of
IUIIUI
Couple:
(Age, Duration of infertility, Cause of infertility, BMI).
Treatment:
•Semen processing technique.
•Protocol of COH.
•Timing of insemination.
• Age
• Semen source and quality
• No of follicles
• Reason for treatment
• Previous treatment cycles
• Failure of treatment
• Pelvic infection: 0.01-0.2%
• Uterine contractions and anaphylaxis
• OHSS < 1%
• Multiple pregnancy
• Ectopic pregnancy
• Miscarriages
• Pain and vaso vagal attack
CONCLUSIONCONCLUSION
While many gynecologists offer IUI office
procedure, many of them are not specialized
enough to provide a comprehensive service.
This means that:This means that:
1. Patients need to run from gynecologist to
ultrasound scan center to the lab.
2. Fragmented care because of poor coordination.
SOSO
An ideal clinic is that which offers
all the services under one roof.
Thank You
Say No
to
Cervical
Cancer

Contenu connexe

Tendances

Progestin-primed ovarian stimulation (PPOS) is a NEW DAW...
Progestin-primed ovarian stimulation (PPOS)                      is a NEW DAW...Progestin-primed ovarian stimulation (PPOS)                      is a NEW DAW...
Progestin-primed ovarian stimulation (PPOS) is a NEW DAW...Lifecare Centre
 
Intrauterine Insemination UPDATE 2018
Intrauterine Insemination UPDATE 2018 Intrauterine Insemination UPDATE 2018
Intrauterine Insemination UPDATE 2018 Lifecare Centre
 
Role of LH in Controlled Ovarian Stimulation
Role of LH in Controlled Ovarian StimulationRole of LH in Controlled Ovarian Stimulation
Role of LH in Controlled Ovarian StimulationSandro Esteves
 
MANAGEMENT OF POOR RESPONDERS IN IVF BY DR SHASHWAT JANI
MANAGEMENT OF POOR RESPONDERS  IN IVF BY DR SHASHWAT JANIMANAGEMENT OF POOR RESPONDERS  IN IVF BY DR SHASHWAT JANI
MANAGEMENT OF POOR RESPONDERS IN IVF BY DR SHASHWAT JANIDR SHASHWAT JANI
 
ENDOMETRIAL PREPARATION IN FROZEN EMBRYO TRANSFER CYCLES
ENDOMETRIAL PREPARATION IN FROZEN EMBRYO TRANSFER CYCLESENDOMETRIAL PREPARATION IN FROZEN EMBRYO TRANSFER CYCLES
ENDOMETRIAL PREPARATION IN FROZEN EMBRYO TRANSFER CYCLESAboubakr Elnashar
 
Antagonist - Tips and tricks to optimize use in Intra Uterine Insemination (I...
Antagonist - Tips and tricks to optimize use in Intra Uterine Insemination (I...Antagonist - Tips and tricks to optimize use in Intra Uterine Insemination (I...
Antagonist - Tips and tricks to optimize use in Intra Uterine Insemination (I...Anu Test Tube Baby Centre
 
Optimizing iui results
Optimizing iui resultsOptimizing iui results
Optimizing iui resultsvandana bansal
 
Endometrial receptivity assay, by Dr.Gayathiri
Endometrial receptivity assay, by Dr.Gayathiri Endometrial receptivity assay, by Dr.Gayathiri
Endometrial receptivity assay, by Dr.Gayathiri Morris Jawahar
 
Optimal endometrial preparation for frozen embryo transfer cycles
Optimal endometrial preparation for frozen embryo transfer cyclesOptimal endometrial preparation for frozen embryo transfer cycles
Optimal endometrial preparation for frozen embryo transfer cyclesnermine amin
 
Novel treatments to trigger final follicular maturation and luteal phase support
Novel treatments to trigger final follicular maturation and luteal phase supportNovel treatments to trigger final follicular maturation and luteal phase support
Novel treatments to trigger final follicular maturation and luteal phase supportSandro Esteves
 
Recent advances in stimulation protocols
Recent advances in stimulation protocolsRecent advances in stimulation protocols
Recent advances in stimulation protocolsSandro Esteves
 
PERFORMING EMBRYO TRANSFER. ABOUBAKR ELNASHAR
PERFORMING EMBRYO TRANSFER. ABOUBAKR ELNASHARPERFORMING EMBRYO TRANSFER. ABOUBAKR ELNASHAR
PERFORMING EMBRYO TRANSFER. ABOUBAKR ELNASHARAboubakr Elnashar
 
Management of poor ovarian response
Management of poor ovarian responseManagement of poor ovarian response
Management of poor ovarian responseHesham Gaber
 
Panel IUI by DR SHASHWAT JANI ( Optimizing Success in Intrauterine Inseminati...
Panel IUI by DR SHASHWAT JANI ( Optimizing Success in Intrauterine Inseminati...Panel IUI by DR SHASHWAT JANI ( Optimizing Success in Intrauterine Inseminati...
Panel IUI by DR SHASHWAT JANI ( Optimizing Success in Intrauterine Inseminati...DR SHASHWAT JANI
 
Day3 versus Day5 Embryo Transfer
Day3 versus Day5 Embryo TransferDay3 versus Day5 Embryo Transfer
Day3 versus Day5 Embryo TransferSujoy Dasgupta
 
Recent Trends In Art (2)
Recent Trends In Art (2)Recent Trends In Art (2)
Recent Trends In Art (2)guest7f0a3a
 

Tendances (20)

Progestin-primed ovarian stimulation (PPOS) is a NEW DAW...
Progestin-primed ovarian stimulation (PPOS)                      is a NEW DAW...Progestin-primed ovarian stimulation (PPOS)                      is a NEW DAW...
Progestin-primed ovarian stimulation (PPOS) is a NEW DAW...
 
Intrauterine Insemination UPDATE 2018
Intrauterine Insemination UPDATE 2018 Intrauterine Insemination UPDATE 2018
Intrauterine Insemination UPDATE 2018
 
Role of LH in Controlled Ovarian Stimulation
Role of LH in Controlled Ovarian StimulationRole of LH in Controlled Ovarian Stimulation
Role of LH in Controlled Ovarian Stimulation
 
MANAGEMENT OF POOR RESPONDERS IN IVF BY DR SHASHWAT JANI
MANAGEMENT OF POOR RESPONDERS  IN IVF BY DR SHASHWAT JANIMANAGEMENT OF POOR RESPONDERS  IN IVF BY DR SHASHWAT JANI
MANAGEMENT OF POOR RESPONDERS IN IVF BY DR SHASHWAT JANI
 
Intra uterine insemination for unexplained infertility
Intra uterine insemination for unexplained infertilityIntra uterine insemination for unexplained infertility
Intra uterine insemination for unexplained infertility
 
ENDOMETRIAL PREPARATION IN FROZEN EMBRYO TRANSFER CYCLES
ENDOMETRIAL PREPARATION IN FROZEN EMBRYO TRANSFER CYCLESENDOMETRIAL PREPARATION IN FROZEN EMBRYO TRANSFER CYCLES
ENDOMETRIAL PREPARATION IN FROZEN EMBRYO TRANSFER CYCLES
 
Optimizing IUI Outcome
Optimizing IUI OutcomeOptimizing IUI Outcome
Optimizing IUI Outcome
 
Antagonist - Tips and tricks to optimize use in Intra Uterine Insemination (I...
Antagonist - Tips and tricks to optimize use in Intra Uterine Insemination (I...Antagonist - Tips and tricks to optimize use in Intra Uterine Insemination (I...
Antagonist - Tips and tricks to optimize use in Intra Uterine Insemination (I...
 
Optimizing iui results
Optimizing iui resultsOptimizing iui results
Optimizing iui results
 
Endometrial receptivity assay, by Dr.Gayathiri
Endometrial receptivity assay, by Dr.Gayathiri Endometrial receptivity assay, by Dr.Gayathiri
Endometrial receptivity assay, by Dr.Gayathiri
 
Optimal endometrial preparation for frozen embryo transfer cycles
Optimal endometrial preparation for frozen embryo transfer cyclesOptimal endometrial preparation for frozen embryo transfer cycles
Optimal endometrial preparation for frozen embryo transfer cycles
 
EMPTY FOLLICLE SYNDROME
EMPTY FOLLICLE SYNDROMEEMPTY FOLLICLE SYNDROME
EMPTY FOLLICLE SYNDROME
 
Novel treatments to trigger final follicular maturation and luteal phase support
Novel treatments to trigger final follicular maturation and luteal phase supportNovel treatments to trigger final follicular maturation and luteal phase support
Novel treatments to trigger final follicular maturation and luteal phase support
 
Recent advances in stimulation protocols
Recent advances in stimulation protocolsRecent advances in stimulation protocols
Recent advances in stimulation protocols
 
PERFORMING EMBRYO TRANSFER. ABOUBAKR ELNASHAR
PERFORMING EMBRYO TRANSFER. ABOUBAKR ELNASHARPERFORMING EMBRYO TRANSFER. ABOUBAKR ELNASHAR
PERFORMING EMBRYO TRANSFER. ABOUBAKR ELNASHAR
 
Management of poor ovarian response
Management of poor ovarian responseManagement of poor ovarian response
Management of poor ovarian response
 
Panel IUI by DR SHASHWAT JANI ( Optimizing Success in Intrauterine Inseminati...
Panel IUI by DR SHASHWAT JANI ( Optimizing Success in Intrauterine Inseminati...Panel IUI by DR SHASHWAT JANI ( Optimizing Success in Intrauterine Inseminati...
Panel IUI by DR SHASHWAT JANI ( Optimizing Success in Intrauterine Inseminati...
 
Endometriosis and art
Endometriosis and artEndometriosis and art
Endometriosis and art
 
Day3 versus Day5 Embryo Transfer
Day3 versus Day5 Embryo TransferDay3 versus Day5 Embryo Transfer
Day3 versus Day5 Embryo Transfer
 
Recent Trends In Art (2)
Recent Trends In Art (2)Recent Trends In Art (2)
Recent Trends In Art (2)
 

En vedette

IUI - Intrauterine insemination - how to optimise results
IUI - Intrauterine insemination - how to optimise results IUI - Intrauterine insemination - how to optimise results
IUI - Intrauterine insemination - how to optimise results Dr Aniruddha Malpani
 
10 secrets of success of iui dr. sharda Jain
10 secrets of success of iui dr. sharda Jain10 secrets of success of iui dr. sharda Jain
10 secrets of success of iui dr. sharda JainLifecare Centre
 
International school Gurgaon - www.parasworldschool.com
International school Gurgaon - www.parasworldschool.comInternational school Gurgaon - www.parasworldschool.com
International school Gurgaon - www.parasworldschool.comparasbuildtech2014
 
Iui treatment in delhi - www.southendivf.com
Iui treatment in delhi - www.southendivf.comIui treatment in delhi - www.southendivf.com
Iui treatment in delhi - www.southendivf.comparasbuildtech2014
 
Practical tips for monitoring of an IUI cycle Dr. Jyoti Agarwal Dr, Sharda ...
Practical tips for monitoring  of  an IUI cycle Dr. Jyoti Agarwal Dr, Sharda ...Practical tips for monitoring  of  an IUI cycle Dr. Jyoti Agarwal Dr, Sharda ...
Practical tips for monitoring of an IUI cycle Dr. Jyoti Agarwal Dr, Sharda ...Lifecare Centre
 
Endoscopy in gynaecology
Endoscopy in gynaecologyEndoscopy in gynaecology
Endoscopy in gynaecologyobgymgmcri
 
ovarian stimulation- back to basics
ovarian stimulation- back to basicsovarian stimulation- back to basics
ovarian stimulation- back to basicsparul sehgal
 
Intra uterine insemination iui
Intra uterine insemination   iuiIntra uterine insemination   iui
Intra uterine insemination iuiDr-Najeeb Layyous
 
Intra Uterine Insemination
Intra Uterine Insemination  Intra Uterine Insemination
Intra Uterine Insemination Jyoti Gupta
 
Intrauterine insemination
Intrauterine inseminationIntrauterine insemination
Intrauterine inseminationz2jeetendra
 
Intrauterine insemination (iui)
Intrauterine insemination  (iui)Intrauterine insemination  (iui)
Intrauterine insemination (iui)Hesham Al-Inany
 
How to Deal with Access Injury: Digestive and Vascular
How to Deal with Access Injury: Digestive and VascularHow to Deal with Access Injury: Digestive and Vascular
How to Deal with Access Injury: Digestive and VascularGeorge S. Ferzli
 
Complication of laparoscopy
Complication of laparoscopyComplication of laparoscopy
Complication of laparoscopyTariq Mohammed
 
ovarian hyperstimulation syndrome
ovarian hyperstimulation syndromeovarian hyperstimulation syndrome
ovarian hyperstimulation syndromeHemin Jamal
 
Ovarian Hyperstimulation Syndrome
Ovarian Hyperstimulation SyndromeOvarian Hyperstimulation Syndrome
Ovarian Hyperstimulation Syndromeguest9dc181
 
Laparoscopy complications veress
Laparoscopy complications   veressLaparoscopy complications   veress
Laparoscopy complications veressDr Sumeet Shah
 
OHSS Management in OI/IUI Cycles
OHSS Management in OI/IUI CyclesOHSS Management in OI/IUI Cycles
OHSS Management in OI/IUI CyclesSandro Esteves
 
Agonists and antagonists in controlled ovarian stimulation
Agonists and antagonists in controlled ovarian stimulationAgonists and antagonists in controlled ovarian stimulation
Agonists and antagonists in controlled ovarian stimulationSandro Esteves
 

En vedette (20)

IUI - Intrauterine insemination - how to optimise results
IUI - Intrauterine insemination - how to optimise results IUI - Intrauterine insemination - how to optimise results
IUI - Intrauterine insemination - how to optimise results
 
Intrauterine insemination
Intrauterine inseminationIntrauterine insemination
Intrauterine insemination
 
10 secrets of success of iui dr. sharda Jain
10 secrets of success of iui dr. sharda Jain10 secrets of success of iui dr. sharda Jain
10 secrets of success of iui dr. sharda Jain
 
International school Gurgaon - www.parasworldschool.com
International school Gurgaon - www.parasworldschool.comInternational school Gurgaon - www.parasworldschool.com
International school Gurgaon - www.parasworldschool.com
 
Iui treatment in delhi - www.southendivf.com
Iui treatment in delhi - www.southendivf.comIui treatment in delhi - www.southendivf.com
Iui treatment in delhi - www.southendivf.com
 
Practical tips for monitoring of an IUI cycle Dr. Jyoti Agarwal Dr, Sharda ...
Practical tips for monitoring  of  an IUI cycle Dr. Jyoti Agarwal Dr, Sharda ...Practical tips for monitoring  of  an IUI cycle Dr. Jyoti Agarwal Dr, Sharda ...
Practical tips for monitoring of an IUI cycle Dr. Jyoti Agarwal Dr, Sharda ...
 
Endoscopy in gynaecology
Endoscopy in gynaecologyEndoscopy in gynaecology
Endoscopy in gynaecology
 
ovarian stimulation- back to basics
ovarian stimulation- back to basicsovarian stimulation- back to basics
ovarian stimulation- back to basics
 
Intra uterine insemination iui
Intra uterine insemination   iuiIntra uterine insemination   iui
Intra uterine insemination iui
 
Intra Uterine Insemination
Intra Uterine Insemination  Intra Uterine Insemination
Intra Uterine Insemination
 
Intrauterine insemination
Intrauterine inseminationIntrauterine insemination
Intrauterine insemination
 
Intrauterine insemination (iui)
Intrauterine insemination  (iui)Intrauterine insemination  (iui)
Intrauterine insemination (iui)
 
Assisted reproduction technology
Assisted reproduction technologyAssisted reproduction technology
Assisted reproduction technology
 
How to Deal with Access Injury: Digestive and Vascular
How to Deal with Access Injury: Digestive and VascularHow to Deal with Access Injury: Digestive and Vascular
How to Deal with Access Injury: Digestive and Vascular
 
Complication of laparoscopy
Complication of laparoscopyComplication of laparoscopy
Complication of laparoscopy
 
ovarian hyperstimulation syndrome
ovarian hyperstimulation syndromeovarian hyperstimulation syndrome
ovarian hyperstimulation syndrome
 
Ovarian Hyperstimulation Syndrome
Ovarian Hyperstimulation SyndromeOvarian Hyperstimulation Syndrome
Ovarian Hyperstimulation Syndrome
 
Laparoscopy complications veress
Laparoscopy complications   veressLaparoscopy complications   veress
Laparoscopy complications veress
 
OHSS Management in OI/IUI Cycles
OHSS Management in OI/IUI CyclesOHSS Management in OI/IUI Cycles
OHSS Management in OI/IUI Cycles
 
Agonists and antagonists in controlled ovarian stimulation
Agonists and antagonists in controlled ovarian stimulationAgonists and antagonists in controlled ovarian stimulation
Agonists and antagonists in controlled ovarian stimulation
 

Similaire à 1 iui a z, including techniques of iui & lps Dr. Sharda jain & Team

Fertility Management: Synergy between Endoscopists and Fertility Specialists
Fertility Management: Synergy between Endoscopists and Fertility SpecialistsFertility Management: Synergy between Endoscopists and Fertility Specialists
Fertility Management: Synergy between Endoscopists and Fertility SpecialistsSujoy Dasgupta
 
Pearls of Wisdom in Infertility
Pearls of Wisdom in InfertilityPearls of Wisdom in Infertility
Pearls of Wisdom in InfertilityDr. Jyoti Malik
 
Assisted reproductive technology
Assisted reproductive technology Assisted reproductive technology
Assisted reproductive technology خوله محمد
 
TCM on Patients undergoing IVF
TCM on Patients undergoing IVFTCM on Patients undergoing IVF
TCM on Patients undergoing IVFChu-Feng Wu
 
Difficult Cases in IUI
Difficult Cases in IUIDifficult Cases in IUI
Difficult Cases in IUISujoy Dasgupta
 
vharsha-art-160402111828.pdf
vharsha-art-160402111828.pdfvharsha-art-160402111828.pdf
vharsha-art-160402111828.pdfAbisha62
 
In vitro fertilization
In vitro fertilizationIn vitro fertilization
In vitro fertilizationz2jeetendra
 
Invitro fertilizationa and intrauterine insemination
Invitro fertilizationa and intrauterine insemination Invitro fertilizationa and intrauterine insemination
Invitro fertilizationa and intrauterine insemination z2jeetendra
 
In vitro fertilization
In vitro fertilizationIn vitro fertilization
In vitro fertilizationAnwar Siddiqui
 
The Assisted Reproductive Techniques - ART (IVF, IUI, ZIFT, GIFT, ICSI etc.)
The Assisted Reproductive Techniques - ART (IVF, IUI, ZIFT, GIFT, ICSI etc.)The Assisted Reproductive Techniques - ART (IVF, IUI, ZIFT, GIFT, ICSI etc.)
The Assisted Reproductive Techniques - ART (IVF, IUI, ZIFT, GIFT, ICSI etc.)Muhammad Anas Shamsi
 
Common algorithm of the management of Infertility
Common algorithm of the management of InfertilityCommon algorithm of the management of Infertility
Common algorithm of the management of InfertilityRupal Shah
 
Assessment and preparation of infertile couples before icsi
Assessment and preparation of infertile couples before icsiAssessment and preparation of infertile couples before icsi
Assessment and preparation of infertile couples before icsiAhmed Mowafy
 
In Vitro Fertilization (IVF) : Today and tomorrow
In Vitro Fertilization (IVF) : Today and tomorrowIn Vitro Fertilization (IVF) : Today and tomorrow
In Vitro Fertilization (IVF) : Today and tomorrowAnu Test Tube Baby Centre
 
Rules and regulations of ART
Rules and regulations of ARTRules and regulations of ART
Rules and regulations of ARTsunitafeme
 
Male Infertility- Recent Updates
Male Infertility- Recent UpdatesMale Infertility- Recent Updates
Male Infertility- Recent UpdatesSujoy Dasgupta
 
Prognostic models in infertility
Prognostic models in infertility Prognostic models in infertility
Prognostic models in infertility Hesham Al-Inany
 

Similaire à 1 iui a z, including techniques of iui & lps Dr. Sharda jain & Team (20)

Treatment of decreased ovarian reserve
Treatment of decreased ovarian reserveTreatment of decreased ovarian reserve
Treatment of decreased ovarian reserve
 
Fertility Management: Synergy between Endoscopists and Fertility Specialists
Fertility Management: Synergy between Endoscopists and Fertility SpecialistsFertility Management: Synergy between Endoscopists and Fertility Specialists
Fertility Management: Synergy between Endoscopists and Fertility Specialists
 
Pearls of Wisdom in Infertility
Pearls of Wisdom in InfertilityPearls of Wisdom in Infertility
Pearls of Wisdom in Infertility
 
Assisted reproductive technology
Assisted reproductive technology Assisted reproductive technology
Assisted reproductive technology
 
TCM on Patients undergoing IVF
TCM on Patients undergoing IVFTCM on Patients undergoing IVF
TCM on Patients undergoing IVF
 
Difficult Cases in IUI
Difficult Cases in IUIDifficult Cases in IUI
Difficult Cases in IUI
 
vharsha-art-160402111828.pdf
vharsha-art-160402111828.pdfvharsha-art-160402111828.pdf
vharsha-art-160402111828.pdf
 
In vitro fertilization
In vitro fertilizationIn vitro fertilization
In vitro fertilization
 
Invitro fertilizationa and intrauterine insemination
Invitro fertilizationa and intrauterine insemination Invitro fertilizationa and intrauterine insemination
Invitro fertilizationa and intrauterine insemination
 
In vitro fertilization
In vitro fertilizationIn vitro fertilization
In vitro fertilization
 
Optimizing iui outcome by Dr Laxmi Shrikhande
Optimizing iui outcome by Dr Laxmi ShrikhandeOptimizing iui outcome by Dr Laxmi Shrikhande
Optimizing iui outcome by Dr Laxmi Shrikhande
 
The Assisted Reproductive Techniques - ART (IVF, IUI, ZIFT, GIFT, ICSI etc.)
The Assisted Reproductive Techniques - ART (IVF, IUI, ZIFT, GIFT, ICSI etc.)The Assisted Reproductive Techniques - ART (IVF, IUI, ZIFT, GIFT, ICSI etc.)
The Assisted Reproductive Techniques - ART (IVF, IUI, ZIFT, GIFT, ICSI etc.)
 
Vaginal hysterectomy
Vaginal hysterectomyVaginal hysterectomy
Vaginal hysterectomy
 
Common algorithm of the management of Infertility
Common algorithm of the management of InfertilityCommon algorithm of the management of Infertility
Common algorithm of the management of Infertility
 
Assessment and preparation of infertile couples before icsi
Assessment and preparation of infertile couples before icsiAssessment and preparation of infertile couples before icsi
Assessment and preparation of infertile couples before icsi
 
Complete Guide To Infertility
Complete Guide To InfertilityComplete Guide To Infertility
Complete Guide To Infertility
 
In Vitro Fertilization (IVF) : Today and tomorrow
In Vitro Fertilization (IVF) : Today and tomorrowIn Vitro Fertilization (IVF) : Today and tomorrow
In Vitro Fertilization (IVF) : Today and tomorrow
 
Rules and regulations of ART
Rules and regulations of ARTRules and regulations of ART
Rules and regulations of ART
 
Male Infertility- Recent Updates
Male Infertility- Recent UpdatesMale Infertility- Recent Updates
Male Infertility- Recent Updates
 
Prognostic models in infertility
Prognostic models in infertility Prognostic models in infertility
Prognostic models in infertility
 

Plus de Lifecare Centre

National Tuberculosis elimination programme (NIKSHAY) Big Challenge to GOI : ...
National Tuberculosis elimination programme (NIKSHAY)Big Challenge to GOI : ...National Tuberculosis elimination programme (NIKSHAY)Big Challenge to GOI : ...
National Tuberculosis elimination programme (NIKSHAY) Big Challenge to GOI : ...Lifecare Centre
 
Innovations & Breakthrough in IVF PART 3
Innovations & Breakthrough in IVF PART 3Innovations & Breakthrough in IVF PART 3
Innovations & Breakthrough in IVF PART 3Lifecare Centre
 
Strategies for Improving Success Rates in ART PART
Strategies for Improving Success Rates in ART PARTStrategies for Improving Success Rates in ART PART
Strategies for Improving Success Rates in ART PARTLifecare Centre
 
20 Simple ways for the Indian public to save water on World Water Day : Dr Sh...
20 Simple ways for the Indian public to save water on World Water Day : Dr Sh...20 Simple ways for the Indian public to save water on World Water Day : Dr Sh...
20 Simple ways for the Indian public to save water on World Water Day : Dr Sh...Lifecare Centre
 
Vaccination during Pregnancy & its Importance : Dr Sharda Jain
Vaccination during Pregnancy & its Importance : Dr Sharda JainVaccination during Pregnancy & its Importance : Dr Sharda Jain
Vaccination during Pregnancy & its Importance : Dr Sharda JainLifecare Centre
 
How to optimize success rates in ART? : Dr Sharda Jain
How to optimize success rates in ART? : Dr Sharda JainHow to optimize success rates in ART? : Dr Sharda Jain
How to optimize success rates in ART? : Dr Sharda JainLifecare Centre
 
SOCIALEGG FREEZING : Dr Poorva Bhargav and Dr Sharda Jain
SOCIALEGG FREEZING : Dr Poorva Bhargav  and Dr Sharda JainSOCIALEGG FREEZING : Dr Poorva Bhargav  and Dr Sharda Jain
SOCIALEGG FREEZING : Dr Poorva Bhargav and Dr Sharda JainLifecare Centre
 
White Coat Hypertension During Pregnancy : Dr Sharda Jain
White Coat Hypertension During Pregnancy : Dr Sharda JainWhite Coat Hypertension During Pregnancy : Dr Sharda Jain
White Coat Hypertension During Pregnancy : Dr Sharda JainLifecare Centre
 
White Coat hypertension Why it is Important? : Dr Sharda Jain
White Coat hypertension Why it is  Important? : Dr Sharda JainWhite Coat hypertension Why it is  Important? : Dr Sharda Jain
White Coat hypertension Why it is Important? : Dr Sharda JainLifecare Centre
 
Understanding Blood Pressure Reading During Pregnancy : Dr Sharda Jain
Understanding Blood Pressure Reading During Pregnancy : Dr Sharda JainUnderstanding Blood Pressure Reading During Pregnancy : Dr Sharda Jain
Understanding Blood Pressure Reading During Pregnancy : Dr Sharda JainLifecare Centre
 
Know Your Blood Pressure Understanding Blood Pressure Reading : Dr Sharda Jain
Know Your Blood Pressure Understanding Blood Pressure Reading : Dr Sharda JainKnow Your Blood Pressure Understanding Blood Pressure Reading : Dr Sharda Jain
Know Your Blood Pressure Understanding Blood Pressure Reading : Dr Sharda JainLifecare Centre
 
Still Birth:An Update : Dr Sharda Jain
Still Birth:An Update : Dr Sharda JainStill Birth:An Update : Dr Sharda Jain
Still Birth:An Update : Dr Sharda JainLifecare Centre
 
IRON DEFICIENCY ANEMIA OVERVIEW WITH FOCUS ON PARENTRAL IRON THERAPY : Dr ...
IRON DEFICIENCY ANEMIA  OVERVIEW  WITH FOCUS ON PARENTRAL IRON THERAPY  : Dr ...IRON DEFICIENCY ANEMIA  OVERVIEW  WITH FOCUS ON PARENTRAL IRON THERAPY  : Dr ...
IRON DEFICIENCY ANEMIA OVERVIEW WITH FOCUS ON PARENTRAL IRON THERAPY : Dr ...Lifecare Centre
 
Iron Deficiency Anemia in Pregnancy Role of IV Ferric Carboxymaltose and its ...
Iron Deficiency Anemia in PregnancyRole of IV Ferric Carboxymaltose andits ...Iron Deficiency Anemia in PregnancyRole of IV Ferric Carboxymaltose andits ...
Iron Deficiency Anemia in Pregnancy Role of IV Ferric Carboxymaltose and its ...Lifecare Centre
 
CHECK LIST FOR ART SPECIALIST BEFORE IVF-ICSI FOR PATIENTS SEEKING IVF -ICSI ...
CHECK LIST FOR ART SPECIALIST BEFORE IVF-ICSI FOR PATIENTS SEEKING IVF -ICSI ...CHECK LIST FOR ART SPECIALIST BEFORE IVF-ICSI FOR PATIENTS SEEKING IVF -ICSI ...
CHECK LIST FOR ART SPECIALIST BEFORE IVF-ICSI FOR PATIENTS SEEKING IVF -ICSI ...Lifecare Centre
 
CMV UPDATE Few solid facts about cytomegalovirus (CMV) Infection & New devel...
CMV UPDATE Few solid facts  about cytomegalovirus (CMV) Infection & New devel...CMV UPDATE Few solid facts  about cytomegalovirus (CMV) Infection & New devel...
CMV UPDATE Few solid facts about cytomegalovirus (CMV) Infection & New devel...Lifecare Centre
 
Addressing the challenge of lack of Sleep in INDIA
Addressing the challenge of lack of Sleep in INDIA Addressing the challenge of lack of Sleep in INDIA
Addressing the challenge of lack of Sleep in INDIA Lifecare Centre
 
Addressing Professional stress among Doctors is a crucial issue : Dr Sharda J...
Addressing Professional stress among Doctors is a crucial issue : Dr Sharda J...Addressing Professional stress among Doctors is a crucial issue : Dr Sharda J...
Addressing Professional stress among Doctors is a crucial issue : Dr Sharda J...Lifecare Centre
 
Stress Urinary Incontinence (SUI) : Dr Sharda Jain
Stress Urinary Incontinence (SUI) : Dr Sharda Jain Stress Urinary Incontinence (SUI) : Dr Sharda Jain
Stress Urinary Incontinence (SUI) : Dr Sharda Jain Lifecare Centre
 
Near Miss Cases & Maternal Mortality In India for Nurses : Dr Sharda Jain
Near Miss Cases & Maternal Mortality In India for Nurses : Dr Sharda Jain Near Miss Cases & Maternal Mortality In India for Nurses : Dr Sharda Jain
Near Miss Cases & Maternal Mortality In India for Nurses : Dr Sharda Jain Lifecare Centre
 

Plus de Lifecare Centre (20)

National Tuberculosis elimination programme (NIKSHAY) Big Challenge to GOI : ...
National Tuberculosis elimination programme (NIKSHAY)Big Challenge to GOI : ...National Tuberculosis elimination programme (NIKSHAY)Big Challenge to GOI : ...
National Tuberculosis elimination programme (NIKSHAY) Big Challenge to GOI : ...
 
Innovations & Breakthrough in IVF PART 3
Innovations & Breakthrough in IVF PART 3Innovations & Breakthrough in IVF PART 3
Innovations & Breakthrough in IVF PART 3
 
Strategies for Improving Success Rates in ART PART
Strategies for Improving Success Rates in ART PARTStrategies for Improving Success Rates in ART PART
Strategies for Improving Success Rates in ART PART
 
20 Simple ways for the Indian public to save water on World Water Day : Dr Sh...
20 Simple ways for the Indian public to save water on World Water Day : Dr Sh...20 Simple ways for the Indian public to save water on World Water Day : Dr Sh...
20 Simple ways for the Indian public to save water on World Water Day : Dr Sh...
 
Vaccination during Pregnancy & its Importance : Dr Sharda Jain
Vaccination during Pregnancy & its Importance : Dr Sharda JainVaccination during Pregnancy & its Importance : Dr Sharda Jain
Vaccination during Pregnancy & its Importance : Dr Sharda Jain
 
How to optimize success rates in ART? : Dr Sharda Jain
How to optimize success rates in ART? : Dr Sharda JainHow to optimize success rates in ART? : Dr Sharda Jain
How to optimize success rates in ART? : Dr Sharda Jain
 
SOCIALEGG FREEZING : Dr Poorva Bhargav and Dr Sharda Jain
SOCIALEGG FREEZING : Dr Poorva Bhargav  and Dr Sharda JainSOCIALEGG FREEZING : Dr Poorva Bhargav  and Dr Sharda Jain
SOCIALEGG FREEZING : Dr Poorva Bhargav and Dr Sharda Jain
 
White Coat Hypertension During Pregnancy : Dr Sharda Jain
White Coat Hypertension During Pregnancy : Dr Sharda JainWhite Coat Hypertension During Pregnancy : Dr Sharda Jain
White Coat Hypertension During Pregnancy : Dr Sharda Jain
 
White Coat hypertension Why it is Important? : Dr Sharda Jain
White Coat hypertension Why it is  Important? : Dr Sharda JainWhite Coat hypertension Why it is  Important? : Dr Sharda Jain
White Coat hypertension Why it is Important? : Dr Sharda Jain
 
Understanding Blood Pressure Reading During Pregnancy : Dr Sharda Jain
Understanding Blood Pressure Reading During Pregnancy : Dr Sharda JainUnderstanding Blood Pressure Reading During Pregnancy : Dr Sharda Jain
Understanding Blood Pressure Reading During Pregnancy : Dr Sharda Jain
 
Know Your Blood Pressure Understanding Blood Pressure Reading : Dr Sharda Jain
Know Your Blood Pressure Understanding Blood Pressure Reading : Dr Sharda JainKnow Your Blood Pressure Understanding Blood Pressure Reading : Dr Sharda Jain
Know Your Blood Pressure Understanding Blood Pressure Reading : Dr Sharda Jain
 
Still Birth:An Update : Dr Sharda Jain
Still Birth:An Update : Dr Sharda JainStill Birth:An Update : Dr Sharda Jain
Still Birth:An Update : Dr Sharda Jain
 
IRON DEFICIENCY ANEMIA OVERVIEW WITH FOCUS ON PARENTRAL IRON THERAPY : Dr ...
IRON DEFICIENCY ANEMIA  OVERVIEW  WITH FOCUS ON PARENTRAL IRON THERAPY  : Dr ...IRON DEFICIENCY ANEMIA  OVERVIEW  WITH FOCUS ON PARENTRAL IRON THERAPY  : Dr ...
IRON DEFICIENCY ANEMIA OVERVIEW WITH FOCUS ON PARENTRAL IRON THERAPY : Dr ...
 
Iron Deficiency Anemia in Pregnancy Role of IV Ferric Carboxymaltose and its ...
Iron Deficiency Anemia in PregnancyRole of IV Ferric Carboxymaltose andits ...Iron Deficiency Anemia in PregnancyRole of IV Ferric Carboxymaltose andits ...
Iron Deficiency Anemia in Pregnancy Role of IV Ferric Carboxymaltose and its ...
 
CHECK LIST FOR ART SPECIALIST BEFORE IVF-ICSI FOR PATIENTS SEEKING IVF -ICSI ...
CHECK LIST FOR ART SPECIALIST BEFORE IVF-ICSI FOR PATIENTS SEEKING IVF -ICSI ...CHECK LIST FOR ART SPECIALIST BEFORE IVF-ICSI FOR PATIENTS SEEKING IVF -ICSI ...
CHECK LIST FOR ART SPECIALIST BEFORE IVF-ICSI FOR PATIENTS SEEKING IVF -ICSI ...
 
CMV UPDATE Few solid facts about cytomegalovirus (CMV) Infection & New devel...
CMV UPDATE Few solid facts  about cytomegalovirus (CMV) Infection & New devel...CMV UPDATE Few solid facts  about cytomegalovirus (CMV) Infection & New devel...
CMV UPDATE Few solid facts about cytomegalovirus (CMV) Infection & New devel...
 
Addressing the challenge of lack of Sleep in INDIA
Addressing the challenge of lack of Sleep in INDIA Addressing the challenge of lack of Sleep in INDIA
Addressing the challenge of lack of Sleep in INDIA
 
Addressing Professional stress among Doctors is a crucial issue : Dr Sharda J...
Addressing Professional stress among Doctors is a crucial issue : Dr Sharda J...Addressing Professional stress among Doctors is a crucial issue : Dr Sharda J...
Addressing Professional stress among Doctors is a crucial issue : Dr Sharda J...
 
Stress Urinary Incontinence (SUI) : Dr Sharda Jain
Stress Urinary Incontinence (SUI) : Dr Sharda Jain Stress Urinary Incontinence (SUI) : Dr Sharda Jain
Stress Urinary Incontinence (SUI) : Dr Sharda Jain
 
Near Miss Cases & Maternal Mortality In India for Nurses : Dr Sharda Jain
Near Miss Cases & Maternal Mortality In India for Nurses : Dr Sharda Jain Near Miss Cases & Maternal Mortality In India for Nurses : Dr Sharda Jain
Near Miss Cases & Maternal Mortality In India for Nurses : Dr Sharda Jain
 

Dernier

Role of Soap based and synthetic or syndets bar
Role of  Soap based and synthetic or syndets barRole of  Soap based and synthetic or syndets bar
Role of Soap based and synthetic or syndets barmohitRahangdale
 
MedMatch: Your Health, Our Mission. Pitch deck.
MedMatch: Your Health, Our Mission. Pitch deck.MedMatch: Your Health, Our Mission. Pitch deck.
MedMatch: Your Health, Our Mission. Pitch deck.whalesdesign
 
Male Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy DasguptaMale Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy DasguptaSujoy Dasgupta
 
How to cure cirrhosis and chronic hepatitis naturally
How to cure cirrhosis and chronic hepatitis naturallyHow to cure cirrhosis and chronic hepatitis naturally
How to cure cirrhosis and chronic hepatitis naturallyZurück zum Ursprung
 
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdfSGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdfHongBiThi1
 
Clinical Research Informatics Year-in-Review 2024
Clinical Research Informatics Year-in-Review 2024Clinical Research Informatics Year-in-Review 2024
Clinical Research Informatics Year-in-Review 2024Peter Embi
 
ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptx
ANATOMICAL FAETURES OF BONES  FOR NURSING STUDENTS .pptxANATOMICAL FAETURES OF BONES  FOR NURSING STUDENTS .pptx
ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptxWINCY THIRUMURUGAN
 
Neurological history taking (2024) .
Neurological  history  taking  (2024)  .Neurological  history  taking  (2024)  .
Neurological history taking (2024) .Mohamed Rizk Khodair
 
CPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing studentCPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing studentsaileshpanda05
 
Male Infertility, Antioxidants and Beyond
Male Infertility, Antioxidants and BeyondMale Infertility, Antioxidants and Beyond
Male Infertility, Antioxidants and BeyondSujoy Dasgupta
 
pA2 value, Schild plot and pD2 values- applications in pharmacology
pA2 value, Schild plot and pD2 values- applications in pharmacologypA2 value, Schild plot and pD2 values- applications in pharmacology
pA2 value, Schild plot and pD2 values- applications in pharmacologyDeepakDaniel9
 
Adenomyosis or Fibroid- making right diagnosis
Adenomyosis or Fibroid- making right diagnosisAdenomyosis or Fibroid- making right diagnosis
Adenomyosis or Fibroid- making right diagnosisSujoy Dasgupta
 
Physiology of Smooth Muscles -Mechanics of contraction and relaxation
Physiology of Smooth Muscles -Mechanics of contraction and relaxationPhysiology of Smooth Muscles -Mechanics of contraction and relaxation
Physiology of Smooth Muscles -Mechanics of contraction and relaxationMedicoseAcademics
 
EXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung functionEXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung functionkrishnareddy157915
 
High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)kishan singh tomar
 
historyofpsychiatryinindia. Senthil Thirusangu
historyofpsychiatryinindia. Senthil Thirusanguhistoryofpsychiatryinindia. Senthil Thirusangu
historyofpsychiatryinindia. Senthil Thirusangu Medical University
 
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdf
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdfSGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdf
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdfHongBiThi1
 
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdfSGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdfHongBiThi1
 

Dernier (20)

Role of Soap based and synthetic or syndets bar
Role of  Soap based and synthetic or syndets barRole of  Soap based and synthetic or syndets bar
Role of Soap based and synthetic or syndets bar
 
MedMatch: Your Health, Our Mission. Pitch deck.
MedMatch: Your Health, Our Mission. Pitch deck.MedMatch: Your Health, Our Mission. Pitch deck.
MedMatch: Your Health, Our Mission. Pitch deck.
 
Male Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy DasguptaMale Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy Dasgupta
 
How to cure cirrhosis and chronic hepatitis naturally
How to cure cirrhosis and chronic hepatitis naturallyHow to cure cirrhosis and chronic hepatitis naturally
How to cure cirrhosis and chronic hepatitis naturally
 
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdfSGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
 
Clinical Research Informatics Year-in-Review 2024
Clinical Research Informatics Year-in-Review 2024Clinical Research Informatics Year-in-Review 2024
Clinical Research Informatics Year-in-Review 2024
 
ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptx
ANATOMICAL FAETURES OF BONES  FOR NURSING STUDENTS .pptxANATOMICAL FAETURES OF BONES  FOR NURSING STUDENTS .pptx
ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptx
 
Neurological history taking (2024) .
Neurological  history  taking  (2024)  .Neurological  history  taking  (2024)  .
Neurological history taking (2024) .
 
CPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing studentCPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing student
 
Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...
Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...
Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...
 
Male Infertility, Antioxidants and Beyond
Male Infertility, Antioxidants and BeyondMale Infertility, Antioxidants and Beyond
Male Infertility, Antioxidants and Beyond
 
pA2 value, Schild plot and pD2 values- applications in pharmacology
pA2 value, Schild plot and pD2 values- applications in pharmacologypA2 value, Schild plot and pD2 values- applications in pharmacology
pA2 value, Schild plot and pD2 values- applications in pharmacology
 
Adenomyosis or Fibroid- making right diagnosis
Adenomyosis or Fibroid- making right diagnosisAdenomyosis or Fibroid- making right diagnosis
Adenomyosis or Fibroid- making right diagnosis
 
Physiology of Smooth Muscles -Mechanics of contraction and relaxation
Physiology of Smooth Muscles -Mechanics of contraction and relaxationPhysiology of Smooth Muscles -Mechanics of contraction and relaxation
Physiology of Smooth Muscles -Mechanics of contraction and relaxation
 
EXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung functionEXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung function
 
High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)
 
historyofpsychiatryinindia. Senthil Thirusangu
historyofpsychiatryinindia. Senthil Thirusanguhistoryofpsychiatryinindia. Senthil Thirusangu
historyofpsychiatryinindia. Senthil Thirusangu
 
GOUT UPDATE AHMED YEHIA 2024, case based approach with application of the lat...
GOUT UPDATE AHMED YEHIA 2024, case based approach with application of the lat...GOUT UPDATE AHMED YEHIA 2024, case based approach with application of the lat...
GOUT UPDATE AHMED YEHIA 2024, case based approach with application of the lat...
 
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdf
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdfSGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdf
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdf
 
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdfSGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
 

1 iui a z, including techniques of iui & lps Dr. Sharda jain & Team

  • 2. Faculty • Dr. Sharda Jain Prog. Director , Course Chair • Dr Jyoti Agarwal Director Courses Co- Chair • Dr. Aruna saxena Director Courses Co- Chair • Dr. Jyoti Bhaskar Director • Dr. Abhishek Singh Parihar Director • Dr. Sushma Ved Director
  • 3. DR .ABHISHEK SINGH PARIHARDR .ABHISHEK SINGH PARIHAR • FELLOWSHIP IN REPRODUCTIVE MEDICINE & IVF, CRAFT Hospital,Cochin • Ultrasound training from Craft hospital, Cochin, Kerala and Institute of Ultrasound Training, Delhi • MS Obs & Gyne, RGUHS Bangalore (2008) • MBBS Pondicherry University (2003) AREAS OF CLINICAL INTEREST • Reproductive Medicine, IVF, Andrology Member : • Federation of Obstetrics and Gynecological societies of India (FOGSI) • Ghaziabad Obsterics and Gynecological society • Gynecological Endocrine Society of India (GESI) • Indian Medical Association (IMA), Ghaziabad branch • Delhi Gynecologist’s Forum (DGF) • Indian Fertility Society (IFS) Invited as guest speaker at various societies & Conferences Executive member, Ghaziabad Obs & Gynec Society
  • 4. DR. ABHISHEK SINGH PARIHAR M.S.( OBS & GYNAE), FELLOW REPRODUCTIVE MEDICINE. CONSULTANT : Life care IVF Center, New Delhi Abalone Clinic, Maternity & Fertility Center, NOIDA
  • 5. • Infertility is defined classically as the inability to conceive after 1 year of unprotected and regular intercourse. This definition is based on the cumulative probability of pregnancy.
  • 8. • IUI places sperm directly into the uterus and therefore close to any egg(s). • Less stressful, LESS invasive and expensive than IVF and similar procedures. It is therefore often used when a male partner is subfertile, or when the reason for not becoming pregnant is unknown.
  • 9. • Oldest assisted reproductive technique • Most widely used worldwide • A I techniques were first investigated in the 17th century, as a treatment for infertility related to male sexual dysfunction (e.g. the inability to ejaculate). • Dutch scientists first reported conception following artificial insemination in 1742, when they successfully fertilised the eggs of fish, by artificially inseminating female fish with fish sperm. • Human insemination began in the late 18th century • Instrument called the Fecondateur, a syringe to assist insemination, was developed in 1866.
  • 10. As a technique: •Direct intrauterine insemination (neat semen) - Disadvantage: - PG cramps - Infection. •Split ejaculate •The advances in IVF, ET. reviving IUI. History of IUI Abandoned (Stone et al, 1986)
  • 11. Advances in:- • Progress in semen processing and sperm isolation methods. • Improved ovarian stimulation protocols (developed primarily to meet IVF requirements) →↓ ↓side effects. IUI progress is due to advances in IVF, ET. Reviving the interest in IUI +
  • 12. Advantages of IUIAdvantages of IUI •Bypass ( Vaginal acidity + cervical mucus hostility) •Deposition of a well prepared sperms as close as possible to the oocytes (Short distance) •Non invasive •Inexpensive. •Antenatal & perinatal complications ( similar to pregnancies from normal S I)
  • 13. • Patient selection and work-up • Ovarian stimulation • Monitoring of follicular growth and endometrial development • Timing of insemination • Number of inseminations • Semen preparation • Insemination procedure • Luteal support
  • 14.  Age < 40 years  Patient capable of spontaneous or induced ovulation  Atleast one patent fallopian tube with good tubo- ovarian relationship  Sperm count of more than 10 million/ml pre- wash or a post-wash count of >3-5 million motile sperms with percentage motility of more than 40%  Easy access to the uterine cavity via a negotiable cervical canal
  • 15. Controlled ovarian stimulation along with intrauterine insemination –effective form of treatment - select group of couples.
  • 16. • Male factor • Female factor
  • 17. • Subnormal semen parameters Oligozoospermia, Asthenozoospermia, Teratozoospermia, Hypospermia, Highly viscous semen • Retrograde ejaculation. • Ejaculatory failure- • Anatomical • Neurological • Psychological • Drug induced
  • 18. • Unexplained infertility • Cervical factor ( Cervical mucus hostility, poor cervical mucus ) , Antisperm antibodies • Ovulatory dysfunction (ovulating but no pregnancy and associated with male factor- ESHRE/ASRM) • Minimal to mild endometriosis • Vaginismus • Allergy to seminal plasma • HIV serodiscordant couples
  • 19. • Absentee husband • Anti – neoplastic treatment • Vasectomy • Poor semen parameters • Drug therapy
  • 20. • Severe abnormal semen parameters ( OAT ). • Azoospermia ( OA – CBAVD, NOA) • Hereditary disease in male partner. • Repeated failure at IVF/ICSI. • Infectious disease in male partner( HIV). • Severe Rh incompatibility • Single Women
  • 21. • Tubal pathology • Genital tract infection • Severe male factor infertility • Severe endometriosis • Genetic abnormality in husband • Unexplained genital tract bleeding • Older women more than 40 years • Multiple failures at IUI
  • 22. • Oral drugs • Oral drugs with gonadotropins • Gonadotropins alone • Gonadotropins with Gnrh analogs • Gonadotropins with Gnrh antagonists
  • 23. • Anovulatory women – Monofolliculogenesis. • Ovulatory women – Super ovulation to increase the chance of pregnancy as more eggs will be available for the sperms to fertilize.
  • 24. • Maximizes conception- ideally expressed as singleton live birth at term. • Minimizes multiple pregnancy and OHSS. • Avoiding risks of preterm delivery, perinatal morbidity and mortality to the neonate and risks to the mother from OHSS
  • 25. • HCG • Gnrh AGONIST • Recombinant HCG. • Routine administration of HCG adds little to improving conception rates .Indicated only when absent or delayed ovulation or for timing IUI or intercourse. (Fertil steril 2007)
  • 27. • Standard sperm wash • Swim up • Swim down method • Density gradient
  • 28. • Remove PG’s- cause uterine cramping. • Semen mixed with buffered solution with human serum albumin. • Advanced preparation -selects motile & superior quality sperm. • Dead/ immotile/abnormal sperms- produce 10-15 times more Reactive oxygen species than motile sperms. • High level of ROS – reduces fertilization
  • 29.  Threshold  Pre wash  Total count- 10 million  Motility -30 %  Total motile forms- 5 million  Morphology - 5%  8% VS 2.5% Pregnancy rate per cycle  Post wash  4 – 5 million  50 %
  • 30.  Single IUI.  36 hrs after HCG .  After follicle rupture .  Within 24 hrs of LH surge.  Double IUI.  At 24 and 48hrs after HCG adminstration.  Day 6 and day 8 of last pill .  NO statistical difference in pregnancy rates in different timing regimens. (Esra et al –Fert ster 2009)
  • 31. • RATIONALE- increase opportunity for longer fertilization period (22-47hrs). • No clear benefit in terms of LBR. (TafunBagis etal - Human Rep ,May 2010) • Systematic review of 3 RCT- No difference. (NICE guideline-fertility-2004) • No clear benefit in terms of pregnancy rates. (Meta analysis-Nikalaos-Fert stert Aug.2009.)
  • 32. • Pre- ovulatory USG. Fresh unwashed semen - 6-8 hrs before ovulation. Washed semen – No sooner than 4 hrs after ovulation. Cryopreserved semen – As close to ovulation. • LH testing kit. Within 24 hrs of color change .
  • 33. • Intra vaginal insemination • Intra cervical insemination • Intra uterine insemination • Intra uterine tuboperitoneal insemination • Direct intra peritoneal insemination • Fallopian tube perfusion .
  • 35. • The patient is positioned . • Cervix exposed with cuscos bivalve speculum, excessive vaginal secretions are wiped away and the cervical os is cleansed with the standard buffer solution using a cotton swab. • IUI cannula is flushed with 1-2 ml of flushing media to wash away any toxic factors present.
  • 36. • Specimen ( 0.4- 0.5ml) drawn into the catheter and syringe. • The catheter is gently introduced into the cervix to pass beyond cervical os until the catheter enters the uterus. • The catheter is advanced to a depth of at least 4cm but no more than 6cm to avoid trauma to the endometrium • When the catheter is in place and before ejecting the specimen , the opened forceps is positioned on either side of the cervix and the opposing ends gently squeezed together with just enough pressure to prevent fluid escaping .
  • 37. • The specimen is slowly ejected from the syringe. • The air remaining in the syringe is expressed as the catheter is withdrawn, to form an air block in the cervix. • Pressure on the forceps should be maintained until the cramping subsides, usually within one minute
  • 38. 15 min of bed rest after IUI has shown to improve ongoing pregnancy and LBR (RCT-Custers etal BMJ2009).
  • 39. • Luteal support in IVF cycles is associated with increased pregnancy rates • Luteal support is necessary when Gnrh agonist,hcg and antagonist is used. • Luteal support in the form of various forms of progesterone and HCG can be given depending on the clinical situation.
  • 40. • Oral dydrogesterone 10 mg BD from day of IUI. • Micronized progesterone 100 mg BD vaginally. • Inj. Hcg 3000 iu i.m. once every 3days. • Role of estradiol is not clearly defined.
  • 41. • 08 -14% per cycle for all causes of infertility. • Semen parameters- Count , Motility and Morphology (Van et al—Fert & Ster 2001) (Lee et al –Int.J.Andr,2002)
  • 42. Factors affecting success ofFactors affecting success of IUIIUI Couple: (Age, Duration of infertility, Cause of infertility, BMI). Treatment: •Semen processing technique. •Protocol of COH. •Timing of insemination.
  • 43. • Age • Semen source and quality • No of follicles • Reason for treatment • Previous treatment cycles
  • 44. • Failure of treatment • Pelvic infection: 0.01-0.2% • Uterine contractions and anaphylaxis • OHSS < 1% • Multiple pregnancy • Ectopic pregnancy • Miscarriages • Pain and vaso vagal attack
  • 45. CONCLUSIONCONCLUSION While many gynecologists offer IUI office procedure, many of them are not specialized enough to provide a comprehensive service. This means that:This means that: 1. Patients need to run from gynecologist to ultrasound scan center to the lab. 2. Fragmented care because of poor coordination. SOSO An ideal clinic is that which offers all the services under one roof.