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When is IUI used?

The most common reasons for IUI are a low sperm count or decreased sperm mobility.

However, IUI may be selected as a fertility treatment for any of the following conditions as well:

• Unexplained infertility

• A hostile cervical condition, including cervical mucus problems

• Cervical scar tissue from past procedures which may hinder the sperms’ ability to enter the uterus

• Ejaculation dysfunction

IUI is not recommended for the following patients:

• Women who have severe disease of the fallopian tubes

• Women with a history of pelvic infections

• Women with moderate to severe endometriosis

How does IUI work?

Before intrauterine insemination, ovulation stimulating medications may be used, in which case careful monitoring will be necessary to determine when the eggs are mature. The IUI procedure will then be performed around the time of ovulation, typically about 24-36 hours after the surge in LH hormone that indicates ovulation will occur soon.

A semen sample will be washed by the lab to separate the semen from the seminal fluid. A catheter will then be used to insert the sperm directly into the uterus. This process maximizes the number of sperm cells that are placed in the uterus, thus increasing the possibility of conception. The IUI procedure takes only a few minutes and involves minimal discomfort.

What are the Risks of IUI?

The chances of becoming pregnant with multiples is increased if you take fertility medication when having IUI. There is also a small risk of infection after IUI.

How successful is IUI?

The success of IUI depends on several factors. If a couple has the IUI procedure performed each month, success rates may reach as high as 20% per cycle depending on variables such as female age, the reason for infertility, and whether fertility drugs were used, among other variables. While IUI is a less invasive and less expensive option, pregnancy rates from IUI are lower than those from IVF. If you think you may be interested in IUI, talk with your doctor to discuss your options.

The procedure

For Women

If you are not using fertility drugs, IUI will be performed between day 12 and 16 of your monthly cycle – with day one being the first day of your period. You will be given blood tests or urine tests to identify when you are about to ovulate.

Or:

If you use fertility drugs to stimulate ovulation, vaginal ultrasound scans are used to track the development of your eggs. As soon as an egg is mature, you are given a hormone injection to stimulate its release.

The sperm will be inserted 36–40 hours later. The doctor will first insert a speculum into your vagina, as in a smear test, to keep your vaginal walls apart. A small catheter (a soft, flexible tube) will then be threaded into your womb via your cervix. The best-quality sperm will be selected and inserted through the catheter.

The whole process only takes a few minutes and is usually painless. Some women may experience a temporary, menstrual-like cramping. You may want to rest for a short time before going home.

For Men:

You will be asked to produce a sperm sample on the day the treatment takes place.

The sperm will be washed to remove the fluid surrounding them and the rapidly moving sperm will be separated out from the slower sperm.

The rapidly moving sperm will be placed in a small catheter to be inserted into the womb.

If you are using donated or frozen sperm, it will be removed from frozen storage, thawed and prepared in the same way.

Risks

Intrauterine insemination is a relatively simple and safe procedure, and the risk of serious complications is low. Risks include:

• Infection. There’s a slight risk of developing an infection as a result of the procedure.

• Spotting. Sometimes the process of placing the catheter in the uterus causes a small amount of vaginal bleeding. This doesn’t usually have an effect on the chance of pregnancy.

• Multiple pregnancy. IUI itself isn’t associated with an increased risk of a multiple pregnancy — twins, triplets or more. But, when coordinated with ovulation-inducing medications, the risk of a multiple pregnancy increases significantly. A multiple pregnancy has higher risks than a single pregnancy does, including early labor and low birth weight.

Fertility drugs that you take may cause a number of IUI side effects including:

• Hot flashes.

• Mood swings and depression.

• Nausea, headaches or visual disturbances.

• Swollen and painful ovaries, signaling ovarian hyperstimulation syndrome (OHSS)

• Pelvic discomfort, breast tenderness, or bloating.

• Ovarian cysts.

High Risk pregnancy management
 

1.Should I be concerned if I have spotting or light bleeding while I am taking birth control pills?
   This can be normal if you skipped or were late taking a pill. To avoid this and have the pills be their most effective it is best if you take the     pills at the same time everyday.

2. Is there anything I should do if I am planning to become pregnant?
    If you are taking birth control pills stop taking your pills and wait until you have had two periods before trying to conceive.

3. Does your practice manage high risk pregnancies?
    Normal as well as high-risk pregnancy management is provided by our physicians. Fetal evaluations involving 4-D ultrasound, and     no

Cervical Cancer Screening
 

1. I’m trying to get pregnant – should I have cervical screening?
    We don’t normally recommend that a woman should have cervical screening when she is (or might be) pregnant, but this would depend in an     individual case on her previous history. If you’ve had abnormal smears in the past, for example, or if you haven’t accepted your past     invitations for screening, then you should consult your doctor or practice nurse to ask for advice.

2. When is the best time in the menstrual cycle to have cervical screening?
    Mid-cycle (usually 14 days from the start of your last period) is the best time because a clearer background to the sample can be gained     around this time. This is because the mucus plug is at its thinnest so the sample is less likely to be masked or contain mucus. Also, the     epithelium (lining) is at its thickest so the sample taken contains a full range of cells. But it’s not a strict rule, so do take advice from your     doctor or practice nurse if you can’t make an appointment at that time.

3. Will cervical screening pick up any other infections?
    It might, but that’s not really the aim of the programme which is to detect and treat early abnormalities which, if left untreated, could lead to     cervical cancer. Incidental findings of infections are not part of the NHS Cervical Screening Programme but may be reported and acted upon     according to local protocols.

Hysteroscopic Surgery
 

1. What is hysteroscopy?
    Hysteroscopy provides a way for your physician to look inside your uterus. A hysteroscope is a thin, telescope-like instrument that is inserted     into the uterus through the vagina and cervix. This tool often helps a physician diagnose or treat a uterine problem. Hysteroscopy is minor     surgery which is performed either in your physician’s office or in a hospital setting. It can be performed with local, regional, or general     anesthesia–sometimes no anesthesia is needed. There is little risk involved with this procedure for most women.

2. When is hysteroscopy used?
    Hysteroscopy may be either diagnostic or operative.Diagnostic hysteroscopy is used to diagnose some uterine abnormalities, and may also     be used to confirm the results of other tests such as hysterosalpingography (HSG). Other instruments or techniques, such as dilation and     curettage (D&C) and laparoscopy, are sometimes used in conjunction with the hysteroscopy. Diagnostic hysteroscopy can be used to     diagnose certain conditions such asabnormal uterine bleeding, infertility, repeated miscarriages, adhesions, fibroid tumors, polyps, or to     locate displaced intrauterine devices (IUDs).

    An operative hysterocopy may be used, instead of open abdominal surgery, to both diagnose and treat certain conditions such as uterine     adhesions, septums, or fibroids which can often be removed through the hysteroscope.

    The hysteroscope is sometimes used with other instruments such as the resectoscope to treat some cases of abnormal bleeding; however     after this procedure, known as endometrial ablation, women can no longer have children so it is not an option for women who wish to have     future pregnancies. Endometrial ablation is a procedure which destroys the lining of the uterus. The resectoscope is a telescope-like     instrument with a wire loop, a rollerball, or a roller cylinder tip at the end. Electric current at the end of the tip is used to destroy the uterine     lining. This procedure is usually performed in an outpatient setting.

3. When should hysteroscopy be performed?
    The best time for hysteroscopy is during the first week or so after your period. During this time your physician is best able to view the inside      of the uterus.

 
Laparoscopic Surgery
 

1. What is laparoscopic surgery ?

Translated from the Greek, “Laparoscopy” means examination of the abdomen with a scope, which is also known as an Endoscope. If the procedure is done in the chest it is known as Thoracoscopy. An Endoscope in the bladder is cystoscopy and in the uterus is hysteroscopy and so on. The other terms used are key-hole surgery and laser surgery.

Explaining laparoscopic surgery is best accomplished by comparing it to traditional surgery. With traditional or ‘open’ surgery, the surgeon must make a cut that exposes the area of the body to be operated on. Until a few years ago, opening up the body was the only way a surgeon could perform the procedure. Now, laparoscopy eliminates the need for a large cut. Instead, the surgeon uses a laparoscope, a thin telescope-like instrument that provides interior views of the body.

Although laparoscopy has been used for many years by gynaecologists to evaluate pelvic pathology, most surgeons did not recognize its value until laparoscopic gall bladder operation was done. Since that time, the application of laparoscopic instruments and techniques has greatly improved, and new uses are being developed rapidly.

2. How is it done?

During laparoscopic surgery, we make a small 1/2 inch cut in the skin at the belly button. Then a cannula (thin tube) is introduced in between the muscle fibres without cutting any of the muscle. Through the cannula, the laparoscope is inserted into the patient’s body.

It is equipped with a tiny camera and light source that allow it to send images through a fibre-optic cord to a television monitor. The television monitor shows a high resolution magnified image. Watching the monitor, the surgeon can perform the procedure. While looking inside the patient, further 1/2″ or 1/4″ diameter cannulas are put in depending upon the procedure e.g. one more for a diagnostic laparoscopy, two more for groin hernia repairs and three more for a laparoscopic gall bladder operation. Instruments are introduced through the cannulas and the operation is performed exactly as one would have done the same procedure at an open operation. All fundamentals of surgery are strictly followed during laparoscopic surgery.

Lately single incision laparoscopic surgery ( SILS ) has come up where all instruments are introduced through the same incision ( many but not all procedures can be done in selected patients using this method ).