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Survey: IUI Preparations
Background
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.
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The Question was:Does your clinic offer IUI - Total yes replies= 30
1. The Option: Yes our clinic offers IUI [Results: Yes= 29 No: 1 Total= 30] ANALYSIS
2. The Option: No our clinic does not offer IUI [Results: Yes= 1 No: 29 Total= 30] ANALYSIS
The Question was:What method do you use for IUI prep - Total yes replies= 28
3. The Option: Gradient [Results: Yes= 24 No: 4 Total= 28] ANALYSIS
4. The Option: Semen wash only. [Results: Yes= 3 No: 25 Total= 28] ANALYSIS
5. The Option: Swim Up [Results: Yes= 0 No: 28 Total= 28] ANALYSIS
6. The Option: Any other method (please describe in comments) [Results: Yes= 1 No: 27 Total= 28] ANALYSIS
The Question was:What final gradient do you use? - Total yes replies= 27
7. The Option: <70% final density [Results: Yes= 1 No: 26 Total= 27] ANALYSIS
8. The Option: 70%-80% [Results: Yes= 11 No: 16 Total= 27] ANALYSIS
9. The Option: 81%-90% [Results: Yes= 10 No: 17 Total= 27] ANALYSIS
10. The Option: More than 90% density [Results: Yes= 3 No: 24 Total= 27] ANALYSIS
11. The Option: I do not use density gradient centrifugation. [Results: Yes= 2 No: 25 Total= 27] ANALYSIS
The Question was:What is the main reason you use your method - Total yes replies= 27
12. The Option: Getting and enriched specimen with the best motile sperm [Results: Yes= 14 No: 13 Total= 27] ANALYSIS
13. The Option: getting a cleaner sample for IUI [Results: Yes= 11 No: 16 Total= 27] ANALYSIS
14. The Option: harvesting the most sperm [Results: Yes= 1 No: 26 Total= 27] ANALYSIS
15. The Option: The cost of gradient too high [Results: Yes= 1 No: 26 Total= 27] ANALYSIS
The Question was:Do you have a minimum sperm concentration, motility or morphology for doing IUI? - Total yes replies= 30
16. The Option: Yes, we have a minimum criteria for insemination. (could you describe these criteria in the comments please) [Results: Yes= 20 No: 10 Total= 30] ANALYSIS
17. The Option: No, we do not have a minimum criteria for insemination. [Results: Yes= 10 No: 20 Total= 30] ANALYSIS
The Question was:What insemination volume do you prepare - Total yes replies= 26
18. The Option: We have no specific volume for insemination. [Results: Yes= 1 No: 25 Total= 26] ANALYSIS
19. The Option: We aim for less than 1 ml [Results: Yes= 20 No: 6 Total= 26] ANALYSIS
20. The Option: We aim for between 1-2 mls. [Results: Yes= 1 No: 25 Total= 26] ANALYSIS
21. The Option: We aim for more than 2 mls. [Results: Yes= 4 No: 22 Total= 26] ANALYSIS
The Question was:How many inseminations do you routinely aim for. - Total yes replies= 23
22. The Option: Only 1 insemination [Results: Yes= 15 No: 8 Total= 23] ANALYSIS
23. The Option: We routinely aim for two inseminations. [Results: Yes= 2 No: 21 Total= 23] ANALYSIS
24. The Option: We routinely aim for more than two inseminations. [Results: Yes= 6 No: 17 Total= 23] ANALYSIS
The Question was:Cycle stimulation - Total yes replies= 24
25. The Option: The majority of cycles are natural (no stimulation) [Results: Yes= 8 No: 16 Total= 24] ANALYSIS
26. The Option: The majority of cycles are have Clomid or similar stimulation [Results: Yes= 14 No: 10 Total= 24] ANALYSIS
27. The Option: The majority of cycles have FSH injections (with or without other stimulation) [Results: Yes= 2 No: 22 Total= 24] ANALYSIS
The Question was:Ovulation - Total yes replies= 29
28. The Option: Do you insemination after a hCG induced ovulation [Results: Yes= 19 No: 10 Total= 29] ANALYSIS
29. The Option: Do you insemination after a natural (LH) ovulation [Results: Yes= 7 No: 22 Total= 29] ANALYSIS
30. The Option: Do you insemination after a hCG augmented natural ovulation (LH rise + hCG Injection) [Results: Yes= 3 No: 26 Total= 29] ANALYSIS
The Question was:Who does the insemination? - Total yes replies= 24
31. The Option: Doctor [Results: Yes= 15 No: 9 Total= 24] ANALYSIS
32. The Option: Clinic nurse [Results: Yes= 7 No: 17 Total= 24] ANALYSIS
33. The Option: Neither a doctor or a nurse! [Results: Yes= 2 No: 22 Total= 24] ANALYSIS
The Question was:Minimum total sperm concentration inseminated ( number/ml x volume) - Total yes replies= 22
34. The Option: <1 million motile sperm [Results: Yes= 7 No: 15 Total= 22] ANALYSIS
35. The Option: Between 1 and 2 million motile sperm [Results: Yes= 3 No: 19 Total= 22] ANALYSIS
36. The Option: Between 2.1 and 5 million motile sperm [Results: Yes= 6 No: 16 Total= 22] ANALYSIS
37. The Option: More than 5 million motile sperm [Results: Yes= 6 No: 16 Total= 22] ANALYSIS
The Question was:Time between sample delivery and insemination - Total yes replies= 25
38. The Option: We aim for less than 1 hour [Results: Yes= 8 No: 17 Total= 25] ANALYSIS
39. The Option: We aim for between 1 and 2 hours [Results: Yes= 12 No: 13 Total= 25] ANALYSIS
40. The Option: We aim for between 2 and 4 hours [Results: Yes= 4 No: 21 Total= 25] ANALYSIS
41. The Option: We aim for more than 4 hours or we have no criteria for time between collection and insemination. [Results: Yes= 1 No: 24 Total= 25] ANALYSIS
The Question was:Preparation environment - Total yes replies= 24
42. The Option: The sample for IUI is prepared on the Andrology Workbench [Results: Yes= 3 No: 21 Total= 24] ANALYSIS
43. The Option: The sample for IUI is prepared on a dedicated `clean` Andrology/IVF Workbench [Results: Yes= 8 No: 16 Total= 24] ANALYSIS
44. The Option: The sample for IUI is prepared in a standard laminar flow cabinet. [Results: Yes= 4 No: 20 Total= 24] ANALYSIS
45. The Option: The sample for IUI is prepared in a class II safety laminar flow cabinet. [Results: Yes= 9 No: 15 Total= 24] ANALYSIS
46. The Option: None of the above (Please describe in comments) [Results: Yes= 0 No: 24 Total= 24] ANALYSIS
The Question was:What is your ongoing pregnancy rate (live births/cycle) for women < 35 years - Total yes replies= 22
47. The Option: < 5% [Results: Yes= 1 No: 21 Total= 22] ANALYSIS
48. The Option: 6-10% [Results: Yes= 3 No: 19 Total= 22] ANALYSIS
49. The Option: 11-15% [Results: Yes= 8 No: 14 Total= 22] ANALYSIS
50. The Option: 16-20% [Results: Yes= 8 No: 14 Total= 22] ANALYSIS
51. The Option: >20% [Results: Yes= 2 No: 20 Total= 22] ANALYSIS
The Question was:Minimum criteria for IUI - Total yes replies= 23
52. The Option: No, we do not have a maximum age criteria for IUI [Results: Yes= 16 No: 7 Total= 23] ANALYSIS
53. The Option: We only offer IUI to women < 35 yeas of age [Results: Yes= 5 No: 18 Total= 23] ANALYSIS
54. The Option: We only offer IUI to women < 40 yeas of age. [Results: Yes= 2 No: 21 Total= 23] ANALYSIS
The Question was:Who prepares the IUI sample - Total yes replies= 26
56. The Option: Andrology staff [Results: Yes= 8 No: 18 Total= 26] ANALYSIS
57. The Option: Embryology Staff [Results: Yes= 5 No: 21 Total= 26] ANALYSIS
58. The Option: Our lab staff are multi-skilled so anyone who is rostered on for IUI [Results: Yes= 13 No: 13 Total= 26] ANALYSIS
Comments
#1127 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
#1128 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.
#1131 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.
#1132 writes: Minimum motile sperm inseminated is 1 million in 0.3 ml of culture media.
#1133 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.
#1134 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
#1135 writes: What insemination volume do you prepare; please disregard this answer. I misread the question. The insemination volume is <0.5ml. Thank you.
#1136 writes: We do IUI for women under 44. We do gradiŽnt and wash only - depending on Q.
#1140 writes: We have a minimum criteria for 2million motile sperm for insemination.
 
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