Intrauterine Insemination for Unexplained Infertility Presented by Presented by Ahmed Walid Anwar Morad, M.D Ahmed Walid Anwar Morad, M.D Assistant Professor of Obstetrics and Gynecology Assistant Professor of Obstetrics and Gynecology Banha Faculty of Medicine Banha Faculty of Medicine Egypt Egypt 2013 2013
44
Embed
Intra uterine insemination for unexplained infertility
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
Intrauterine Insemination for
Unexplained InfertilityPresented byPresented by
Ahmed Walid Anwar Morad, M.DAhmed Walid Anwar Morad, M.D
Assistant Professor of Obstetrics and Gynecology Assistant Professor of Obstetrics and Gynecology
Banha Faculty of MedicineBanha Faculty of Medicine
EgyptEgypt
20132013
OBJECTIVES
The main objective of this
presentation is to spotlight on the
role of IUI in the treatment of
unexplained infertility
Unexplained Infertility
Definition
Unexplained infertility means that ,couple does not conceived after 1 year of unprotected vaginal sexual intercourse, with basic infertility evaluation shows no obvious abnormality
(RCOG guidelines,1998; Randolph,2000; ASRM,2006).
Incidence
15% to 30% of infertile couples (ASRM,2006)
Basic investigations for diagnosis of Unexplained infertility
Normal basic semen analysis according to
WHO criteria (WHO ,2010).
Patent fallopian tube confirmed by HSG.
Ovulation confirmed by mid-luteal serum
progesterone level.
In unexplained infertility: the cause is not defined ,so the treatment is empirical (ASRM, 2006).
1. COH: all except sever male factor ( Risks???)(Cohlen ,2002).
2. Vaginal misoprostol.???? (Brown et al,2001; Barroso et al,2001).
3. 10 -15minutes bed rest after IUI (Saleh et al,2000 ; Custers et al, 2009 )
4. Cervical mucous aspiration before IUI (Paasch et al, 2007)
5. Timed intercourse within 12 -18 h period: useful in IUI with low
number of motile sperm inseminated (Huang et al, 1998).
6. Postponing IUI until the observation of follicle rupture by TV
sonography ( PR;25% vs 8.8%) (Kucuk ,2008).
7. US guidance in IUI
(Ramón et al,2009; Oztekin et al,2013)
8. Pre-insemination hydrotubation
(Edelstam et al, 2008; Aboulghar et al, 2010 ; Morad & Abdelhamid , 2012)
1. Treatment of unexplained infertility is empiric as no obvious abnormality was detected.
2. Treatment of unexplained infertility is very much dependent on availability of resources and patients’ age and duration of infertility .
3. OH with IUI is a simple ,cost-effective, least invasive first-line treatment for Unexplained infertility.
4.Couples should be fully informed about the risks of IUI and COH as well as alternative treatment options.
5. In unexplained infertility OH with IUI may be considered while waiting for IVF or when IVF is not affordable.
6. The pregnancy rates of FSP & Standard IUI are similar.
7.Pre-insemination hydrotubation, US guided IUI , cervical mucous aspiration, post-insemination bed rest for 10 min and vaginal misopristol may improve IUI outcome .
8. In unexplained infertility, up to 6 cycles of IUI should be considered before shifting to IVF.