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Survey:IUI Preparations /False
Comment: The IUI survey follows from a recent discussion in Embryomail and from a request from a subscriber. IUI often are overshadowed by IVF but many clinics use it as a pre-IVF treatment option. We have asked for a live birth rate knowing than this will depend on the type of stimulation used, age of the clients, multiple pregnancy rate, etc but it is meant to be a guide only. It started as a survey on sperm preparation but has been expanded to provide a broader summary on methodology.
   
Does your clinic offer IUI
1. Yes our clinic offers IUI
2. No our clinic does not offer IUI
     
What method do you use for IUI prep
3. Gradient
4. Semen wash only.
5. Swim Up
6. Any other method (please describe in comments)
     
What final gradient do you use?
7. <70% final density
8. 70%-80%
9. 81%-90%
10. More than 90% density
11. I do not use density gradient centrifugation.
     
What is the main reason you use your method
12. Getting and enriched specimen with the best motile sperm
13. getting a cleaner sample for IUI
14. harvesting the most sperm
15. The cost of gradient too high
     
Do you have a minimum sperm concentration, motility or morphology for doing IUI?
16. Yes, we have a minimum criteria for insemination. (could you describe these criteria in the comments please)
17. No, we do not have a minimum criteria for insemination.
     
What insemination volume do you prepare
18. We have no specific volume for insemination.
19. We aim for less than 1 ml
20. We aim for between 1-2 mls.
21. We aim for more than 2 mls.
     
How many inseminations do you routinely aim for.
22. Only 1 insemination
23. We routinely aim for two inseminations.
24. We routinely aim for more than two inseminations.
     
Cycle stimulation
25. The majority of cycles are natural (no stimulation)
26. The majority of cycles are have Clomid or similar stimulation
27. The majority of cycles have FSH injections (with or without other stimulation)
     
Ovulation
28. Do you insemination after a hCG induced ovulation
29. Do you insemination after a natural (LH) ovulation
30. Do you insemination after a hCG augmented natural ovulation (LH rise + hCG Injection)
     
Who does the insemination?
31. Doctor
32. Clinic nurse
33. Neither a doctor or a nurse!
     
Minimum total sperm concentration inseminated ( number/ml x volume)
34. <1 million motile sperm
35. Between 1 and 2 million motile sperm
36. Between 2.1 and 5 million motile sperm
37. More than 5 million motile sperm
     
Time between sample delivery and insemination
38. We aim for less than 1 hour
39. We aim for between 1 and 2 hours
40. We aim for between 2 and 4 hours
41. We aim for more than 4 hours or we have no criteria for time between collection and insemination.
     
Preparation environment
42. The sample for IUI is prepared on the Andrology Workbench
43. The sample for IUI is prepared on a dedicated `clean` Andrology/IVF Workbench
44. The sample for IUI is prepared in a standard laminar flow cabinet.
45. The sample for IUI is prepared in a class II safety laminar flow cabinet.
46. None of the above (Please describe in comments)
     
What is your ongoing pregnancy rate (live births/cycle) for women < 35 years
47. < 5%
48. 6-10%
49. 11-15%
50. 16-20%
51. >20%
     
Minimum criteria for IUI
52. No, we do not have a maximum age criteria for IUI
53. We only offer IUI to women < 35 yeas of age
54. We only offer IUI to women < 40 yeas of age.
     
Who prepares the IUI sample
56. Andrology staff
57. Embryology Staff
58. Our lab staff are multi-skilled so anyone who is rostered on for IUI
     
     
Comments      
#0 writes: main reason we use gradient is to clean prep and get as much sperm as possible (13 and 14) Ovulation is both 28 and 29 Minimum criteria for insemation-an assessment is done prior to insemination and a patient needs to have a tmc of >10 million post density gradient and a tmc of > 1 million post swim, if they don't meet these markers, they are not recommended for IUI treatment Minimum total sperm concentrated inseminated-whatever we end up with after density gradient is inseminated but would like to see greater then 10 million motile sperm
#0 writes: Each physician determines whether a couple is a good candidate for IUI, but generally we like to see at least 10 million motile sperm and normal morphology by WHO 2010 criteria. It would have been interesting to know the number of IUIs with husband sperm and IUIs with donor sperm performed annually. We performed 280 last year, 20% donor. Other questions that would be interesting: 1. Timing of IUI after detecting of LH surge in natural cycles 2. Limit to how many IUIs a couple receives before they must move on to IVF, donor IUI or adoption The following questions were hard to answer: What final gradient do you use? We use either a 2-step 45%/90% gradient, or a 45% only gradient depending on the semen quality. Cryopreserved semen always gets the 45% only What insemination volume do you prepare The insemination volume cannot be greater than 0.5 mL. That answer should be included. The uterus will not accommodate more. Everyone should be doing this. Ovulation I left this blank because we do all 3 depending on patient characteristics Minimum total sperm concentration inseminated I left this blank because for low sperm numbers, we let the patient decide after counseling about benefits and risks. The physician is notified if there are less than 5 million motile sperm so he/she knows that this discussion with the patient will be necessary.
#0 writes: Disregard one of the responses to "who does the insemination?" I read it wrong; I thought it said "either" while it actually states "neither". Thanks.
#0 writes: Minimum motile sperm inseminated is 1 million in 0.3 ml of culture media.
#0 writes: We aim for up to 4 cycles of FSH stimulated IUI with an hCG trigger - over response leads to potential conversion to IVF Insemination will be carried out irrespective of final number of motile sperm but we aim for >5million. Typically trial preparations are carried out where samples have borderline parameters before joining the IUI programme. Where an insemination is carried out with significantly <5 million motile sperm, the treatment plan is reviewed before proceeding with any further treatment.
#0 writes: would like a survey on various sperm preparation techniques and any consensus on how , what , which is the best method to get bes tresults as we have so many experiwenced people here let sshare and improve wher ewe lack
#0 writes: What insemination volume do you prepare; please disregard this answer. I misread the question. The insemination volume is <0.5ml. Thank you.
#0 writes: We do IUI for women under 44. We do gradiŽnt and wash only - depending on Q.
#0 writes: We have a minimum criteria for 2million motile sperm for insemination.
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