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Ovarian stimulation for IUI.
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One of the easiest and most cost effective
protocols for COHS in IUI is the Clomid
(CC)-IUI protocol - Tablets of CC are administered
in a dose of 50 - 100 mg once daily form day 2 or
3 of menses - Transvaginal USG follicular
monitoring being performed daily from day 7 of
cycle until the lead follicle (Egg) reaches 17 -
18 mm in mean diameter and endometrium (lining of
the uterus) reaches f thickness of > 8 mm when
5000 IU of hCG (ovulation trigger injection) is
administered and IUI is performed at 24 and 44
hours post hCG. Luteal phase support is with hCG
1000 IU administered on days 1,4 and 7, assuming
day 0 as day of follicular rupture.
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CC-hMG: CC is administered in a dose of 100 mg
daily from days 3 - 7 of menses. Inj hMG 150
IU is then administered from day 7 of cycle on
a daily basis until the lead follicle reaches
17 - 18 mm in mean diameter. hCG 5000 units is
administered on that day and IUI performed on
2 days thereafter.
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FSH-IUI: After a baseline scan
on day 2 to ensure endometrial shedding and no
residual ovarian cysts, Injections of FSH 150
IU are administered Intramuscularly daily. Begin
TVS monitoring on day 6. If there are more than 3
follicles 12 mm in mean diameter, the same dose
is continued. If less than 3 follicles 12 mm in
diameter, the dose might be increased to 225
IU per day . The ovulation trigger of hCG 5000
IU is then administered when the lead follicle
reaches 18 mm in mean diameter followed by IUI
on two days thereafter.
Sometimes, doctor might combine a GnRh agonist or antagonist with the FSH stimulation for enhancing the results and better timing of ovulation.
SPERM PREPARATION FOR IUI
The sperm is prepared in the semen laboratory by
either of two methods, namely layering or gradient
and the final washed sperm is then loaded in a catheter
and tranfered to the womb (IUI).
RESULTS
The average success rate of IUI per cycle is 8 - 18 %
depending upon the indicaiton and the COHS protocol used.
NUMBER OF CYCLES
The normal recommendations are 3 - 6
cycles of IUI prior to resort to more
aggressive ART such as IVF & ICSI. For the
unexplained infertility group, current
recommendations are two cycles of CC-hCG-IUI,
followed by two cycles of Pure FSH-hMG-IUI followed
by two cycles of FSH-IUI with agonist or antagonist.
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