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Intrauterine Insemination for Unexplained Infertility

Presented by Ahmed Walid Anwar Morad, M.D Assistant Professor of Obstetrics and Gynecology Banha Faculty of Medicine Egypt 2013. Intrauterine Insemination for Unexplained Infertility. OBJECTIVES.

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Intrauterine Insemination for Unexplained Infertility

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  1. Presented by Ahmed Walid Anwar Morad, M.D Assistant Professor of Obstetrics and Gynecology Banha Faculty of Medicine Egypt 2013 Intrauterine Insemination for Unexplained Infertility

  2. OBJECTIVES The main objective of this presentation is to spotlight on the role of IUI in the treatment of unexplained infertility

  3. Unexplained Infertility

  4. 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)

  5. 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.

  6. In unexplained infertility: the cause is not defined ,so the treatment is empirical (ASRM, 2006). Expectant Encourage Advice Inform Active IUI Oral stimulating agents (CC / letrozole) CC+ IUI Gonadotropin injections with or without IUI IVF/ICSI Alternatives: Bromocriptine, Danazol, Tubal flushing.

  7. Treatment Dependent on: Availability of resources , Patients’ age , Duration of infertility. The standard protocol is to: Progress from simple to complex treatment options, Balance the effectiveness against the cost and side effects. (Ray et al,2012)

  8. Suggested Protocol for Management of Unexplained Infertility (Ray et al, 2012)

  9. The role of IUI in treatment of unexplained infertility

  10. IUI • Definition • Rationale • Other indications of IUI • Steps • Advantages • Complications • Indications of IUI in unexplained infertility • Effectiveness of IUI in unexplained infertility

  11. Intrauterine Insemination Definition IUIinvolves the placement of processed semen into the uterine cavity around the time of ovulation (Allahbadia and Merchant,2012).

  12. Rationale increase the rate of conception by increasing the chance that maximum number of healthy sperms reaches the site of fertilization(ESHRE,2009).

  13. Indications I. Male: 1. Ejaculatory failure: ( sever hypospadius ;retrograde ejaculation; impotence) 2. Male factor infertility (mild ;moderate) 3. Sperm cryopreservation prior to treatment ofhusband cancer. 4. Processed semen of HIV + husband for HIV negative women(NICE, 2013)

  14. II. Female: 1.Cervical factor infertility 2. Endometriosis 3. Ovulatory dysfunction 4. Combined non-tubal infertility factors III. Combined: 1.Unexplained infertility • 2. Immunological infertility

  15. Steps Patient selection & counseling. Natural cycle IUI Stimulated cycle IUI (Ovarian stimulation) Monitoring of treatment Sperm preparation Insemination

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