Selection of Protocol for IUI(Intra uterine insemination)

Q . When to use Ov inducing agents in an IUI cycle? Routinely or selectively?? Limitations of OI agents & or IUI?  Only when there is 1) documented anovulation b) has documented luteal deficiency.

Q. How can one  limit the preliminary investigations based on symptoms and signs of the female partner to minimise the cost of therapy?

Ask her to carry out following selective tests as per symptoms. But if one can afford then it will be wise to order for all tests:-,But as a minimum PRL, TSH is mandatory for all cases .But if she is having  Irregular cycles/ Oligomenorrhoea. /anenorrhoea: then  one has to do Followimg  tests (though not all tests result are predictive of disease) -1) Fast Glucose/Insulin ratio 2) DHEASO4, 3) Fast Glucose/Insulin  ratio, FSH & LH;

Investigations cost money: Must be rational & whatever investigation U ask must be cost effective . Your degree of suspicion is important in omitting some unnecessary investigations.  Part II, Basic Protocol:  Selection of agents:  If yes, then what agents will  most likely going to help her? Proceed investigation as per her symptoms: Not all  women warrant Testosterone,  Insulin or DHEASO4  estimation!! Select the protocol  (to use drugs ) depending  on   Investigate & Chose a protocol

TSH & PRL as a minimum.

Symptoms	What tests to order	Preferred Protocol
Amenorrhoea, Oligomeno; Menst disorders	DHEASO4, FSH, LH, Glucose/Insulin.
Regular menstrual cycle	Only TSH, PRL.
Amenorrhoea	FSH, E2, PRL, Preg Test of urine.
Androgen Excess Disorder	DHEASO4, 17-OHP, Glucose/Insulin. LH,FSH,E2
Galactorrhoea	PRL, MRI brain.