Manual of Intrauterine Insemination and Ovulation Induction

Half-title......Page 3
Title......Page 5
Copyright......Page 6
Contents......Page 7
Contributors......Page 8
Preface......Page 9
Introduction......Page 11
Intrauterine insemination: natural and stimulated (OI) cycles......Page 12
Results of treatment by IUI and OI with husband/partner sperm......Page 13
Cost-effectiveness of IUI and OI......Page 14
References......Page 15
Introduction......Page 17
Penis physiology......Page 18
Varicocele......Page 19
Infection......Page 20
Ejaculatory duct obstruction......Page 21
Ejaculatory dysfunction......Page 22
Inhibited ejaculation / anejaculation......Page 23
Retrograde ejaculation......Page 24
Erectile dysfunction......Page 25
Use of ultrasound in male infertility......Page 26
References......Page 27
Ovulation disorders......Page 29
Hypothalamic–pituitary (HP) causes of amenorrhea and ovulatory dysfunction......Page 30
Polycystic ovaries (PCO), polycystic ovary syndrome (PCOS)......Page 31
Premenopause, menopause......Page 32
Peritoneal disorder (endometriosis)......Page 33
Cervical factor......Page 34
Infection......Page 35
When to start evaluation......Page 36
Length of treatment......Page 37
Prediction of future fertility (vetting)......Page 38
References......Page 39
Semen collection room......Page 41
Clinic and laboratory personnel......Page 42
Equipment......Page 43
Clinic and laboratory safety......Page 44
References......Page 46
Introduction......Page 47
Semen and sperm assessment for IUI......Page 51
Specimen collection......Page 52
Volume......Page 53
Sperm count using the hemocytometer......Page 54
Storage......Page 55
Procedure......Page 56
DNA fragmentation......Page 57
Postcoital (Sims–Huhner) test......Page 58
References......Page 59
Acquisition and initial handling of the sperm specimen......Page 63
Media for sperm processing......Page 65
Procedure......Page 66
DGC procedure......Page 68
Rapid SWD procedure (requires centrifugation)......Page 71
GM procedure......Page 73
Procedure......Page 75
References......Page 76
Action......Page 78
Preparation for ovulation induction......Page 80
Notes regarding the basic protocol......Page 82
Use of body weight to select the initial dose of CC or TMX......Page 83
Use of preovulatory ultrasound (US) to evaluate endometrial receptivity......Page 84
Treatment results......Page 85
References......Page 88
Composition of therapeutic gonadotropins......Page 90
Differences between natural and gonadotropin cycles: threshold hypothesis......Page 92
Preparation for ovulation induction......Page 93
Stimulation day (SD) 6–8......Page 94
Use of frequent serum LH measurements to detect the start of a spontaneous LH surge......Page 95
Low-dose gonadotropins......Page 96
Conclusion......Page 98
References......Page 99
Measurement technique......Page 103
Follicular phase day 3......Page 105
Follicular phase day 6: appearance of the dominant follicle......Page 106
Follicular phase day 12: endometrial pattern......Page 107
Follicular phase day 12: endometrial thickness......Page 108
Luteal phase day 21......Page 109
Ovarian cysts......Page 111
Sonohysterography (SHG) for endometrial polyps, endometrial adhesions, submucosal fibroids and hydrosalpinges......Page 113
Uterine anomalies, uterine leiomyomata: three-dimensional ultrasound......Page 115
References......Page 116
Indications for IUI......Page 119
Timing the IUI......Page 120
Vaginal insemination (IVI): suitable for high-quality sperm, does not require washed semen......Page 121
Procedure: without forceps......Page 122
Procedure......Page 123
Fallopian tube sperm perfusion (FSP); intrauterine tuboperitoneal insemination (IUTPI)......Page 124
Infection......Page 125
Conclusion......Page 126
References......Page 127
Indications......Page 129
Sperm freezing technique......Page 130
Sperm storage......Page 131
Computerized stage freezing method......Page 133
Establishing a donor sperm bank......Page 134
Shipping frozen sperm......Page 135
Conclusions......Page 136
References......Page 137
Donor insemination practice......Page 140
International shipping of donor sperm......Page 141
Number of babies per donor......Page 142
Handling and thawing the specimen......Page 143
Thawing straws......Page 144
References......Page 145
Introduction......Page 148
Nurse-assisted insemination......Page 149
Further reading......Page 150
Patient factors that increase the risk of neonatal and maternal morbidity in multiple pregnancy......Page 151
Use of clomiphene citrate (CC) or tamoxifen (TMX) initially......Page 152
Minimal doses of gonadotropins......Page 153
Using hMG instead of FSH, and addition of hCG or rLH during the late proliferative phase......Page 154
Aspiration of supernumerary follicles......Page 155
Miscarriage......Page 156
References......Page 158
Severe OHSS......Page 161
Prevention of ovarian hyperstimulation syndrome......Page 162
Decrease in hCG dosage, use of alternatives to hCG to trigger ovulation......Page 163
In-hospital management of severe OHSS......Page 164
Circulatory volume correction......Page 165
Diuretics......Page 166
Autotransfusion of ascitic fluid......Page 167
Other surgery......Page 168
References......Page 169
Intrauterine insemination using donor sperm......Page 170
Use of an unknown donor......Page 171
The insemination procedure......Page 172
Single women and intrauterine insemination......Page 173
Websites......Page 174
Guidelines, regulations and commissions......Page 175
Access......Page 176
Screening of donors......Page 181
Donor anonymity and informing the offspring......Page 182
Surrogacy......Page 183
Posthumous conception......Page 184
Protestant......Page 185
Confucianism......Page 186
References......Page 187
Index......Page 191