Modes of Ovulation Induction if designed for IUI-Combination of CC & Gonadotrophins

 Causes of Failed Repeated IUI- What should be the combinations of CC & IUI in IUI cycles??

A)In PCO mode of stimulation will be either  CC or FSH:-- max dose of clomiphene :: in the era  of gonadotrophins ,?  Ans:- how much max dose of clomiphene one should  give before switching over to injectable (in  not ART pts )

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 One can go upto 150 mg and find it extremely useful to try this dose before resorting to gonadotropins.  What about Gonadotrophins in IUI for PCO:- If one at all switches over to gonadotrophins  for pcos maximum cost effective dose will be 75 i.u daily and never to exceed that :-Red flag :-warning  more than that will cause ohss.
B) If one is using for unexplained or mild male factor or mild endometriosis: No CC, no letrozole:  use Gonadotrophins only if one is planning for IUI, to promote multi follicular development to improvise IUI results.

Why not gonadotrophins in PCO initially :- As per the expert opinion published in Fert Ster the only indications of using gonadotropin in non-IVF stimulation are
1) hypo hypo type 1 anovulation
2) cc resistant pcos.
3) Premature ovarian failure
4) Hypothyroidism
5) Hyperprolactinemia

CC & Gonadotrophins.-Different schedules.

Schedule 1 :-In this scenario 75 IU daily or 150 on alternate day should suffice adjutant to CC

 Many start 75 u alt days from day 3 ?? 

1)Schedule 2:-  One can  give cc 100 to max 150mg daily D3 to D7. call her on D8 .if no follicle on either side is nearer to 9mm, then and then only one should Supplemt HMG-150 on alternate day for two doses and depending on response making it daily or reduce frequency in same cycle and  also in next cycle.

 Schedule 3:-If one is in a mind to  add only one dose of Gonadotrophin that may be used  on D9 in CC  cycle.
Schedule 4:-If one is accustomed to supplement hMG with CC then preferable is to add two doses give on D6 and D8
Schedule 5  :-There is another way of supplement  i.e to give daily or alternate day start from D6 or D8 .
Another interesting way of using gonadotropins

Schedule 6 :-Start gonadotrophins for 5 days D2,3,4,5,6. Add CC 50mg 8hourly from day 6 till trigger. Reason:-This will take care of thin endometrium as well LH surge. Explanations of late initiation of CC :- Details of Schedule 5:- Gonadotrophin initially and late CC 8 hourly :: plus late CC:-To Start for Gonadotrophin  for 5 days like  D2,3,4,5,6
Add CC 50mg 8hourly from day 6 till trigger Scheduled  

2)

3) All HEPES/ MOPS buffered from refrigerator needs to be brought to 37deg C by incubating at 37deg C for minimum 3hours prior to use and Maximum 12-hours prior to use. If using 2) Bicarbonate buffered media then same be brought to 37deg C and 5-6% CO2 by incubating in CO2 incubator for 6-12 hours prior to use. This done to ensure proper temperature and pH equilibration of the media prior to use

 how many times we should go for iui in one cycle .

How is your record keeping and fu . Unbelievable.

·         Compromise 7:-To perform IUI between 40-42 hours post HCG, Mistake 11 :
Ensure that  ultrasonographically the evidence of rupture of follicles prior to IUI.

1)All HEPES/ MOPS buffered from refrigerator needs to be brought to 37deg C by incubating at 37deg C for minimum 3hours prior to use and Maximum 12-hours prior to use. If using 2) Bicarbonate buffered media then same be brought to 37deg C and 5-6% CO2 by incubating in CO2 incubator for 6-12 hours prior to use. This done to ensure proper temperature and pH equilibration of the media prior to use.

The media is also perfect. Do you equilibrate the media? If yes how do you equilibrate? Please update. Can be a problem in equilibration.

 Firstly I put 2 mil of lower density in gradient & then 2 ml of higher density gradient at the bottom of conical tube with 1.5 inch needle than I pour pts semen above all. Centrifuge at 1500 rpm for 15 min.

 asked about media equilibration how one  equilibrate the media and where one equilibate ones media