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IUI (Intra-uterine insemiuation)


  1. Male factor infertility (sperm counts between 5 and 20 million/mL). If sperm count is less than 5 million/mL, IUI is ineffective (Success rate 8-20%)
  2. Unexplained infertility (treatment of choice is superovulation + IUI)
  3. Antisperm Antibody in cervical mucus
  4. Erectile dysfunction/impotency
  5. Semen deposition problem (epispadias/hypospadias/penile deformities)
  6. Vaginismus
  7. Retrograde ejaculation (Immediate postcoital urine is collected. Semen is then separated from urine)
    • Patent fallopian tube is prerequisite. Fallopian tubes have to be patent for IUI to be successful. If fallopian tubes are blocked, IUI should not be done.
    • In IUI, the semen sample is washed/prepared (swim-up technique/swim-down technique)
    • The dead sperms/ debris and immotile sperms are removed; only highly motile good-quality sperms are taken, and 0.5-0.7 mL sample is injected into the uterine cavity at the time of ovulation.

Assisted reproductive technology

If the sperm count is less than 5 million/mL: (Between 3-5 million)

The options are:

  1. IVF / ICSI
  2. IUI-D (donor)
  3. Adoption

In vitro fertilization and embryo transfer (IVF-ET)



  • Tubal pathology /blocks
  • Male factor: count less than 5 million/mL
  • 6 IUI failures

Basic steps of IVF:

  • Ovarian stimulation with gonadotropins and follicular monitoring
  • Oocyte retrieval (ovum pickup) done through TVS-guided needle
  • Fertilization: 50,000 sperms are put on each oocyte retrieved
  • Embryos kept in incubator for 48-72 h
  • ET done on day 2 or day 3 (48-72 h) after oocyte retrieval
  • Generally 3-4 embryos are transferred in the uterine cavity via catheter and deposited 1 cm below the fundus
  • Success rate of IVF per cycle is 30 - 35%
  • Take home baby rate 24%

Intracytoplasmic sperm injection (ICSI) (micromanipulation)


Indications: Sperm count very low –2000.

  1. Severe oligo-astheno-teratospermia
  2. Azoospermia
  3. Repeated fertilization failure in IVF

The steps are identical to IVF (oocyte retrieval and embryo transfer), but for fertilization, one sperm is mechanically injected into one oocyte.


Success rate of ICSI per cycle is 30-35%. Sperm retrieval techniques in case of azoospermia before doing ICSI:

  • PESA= percutaneous epididymal sperm aspiration (most commonly used)
  • MESA= microscopic epididymal sperm aspiration (Best to be done)
  • TESA= testicular sperm aspiration
  • TESE= testicular sperm extraction (testicular biopsy)

Preimplantation Genetic Diagnosis (PGD)

  • PGD allows couples with various single-gene disorders and X-linked genetic diseases to avoid transmission of the disorder of off spring.
  • Proceeds by biopsy and genetic analysis of one of the following specimens:
    • 1 to 2 blastomeres of a cleavage-stage (days 2 to 3) embryo derived from IVF.
    • Polar body biopsy from a metaphase II oocyte obtained after COH.
    • Trophectoderm tissue from a blastocyst-stage (day 5) embryo.
  • Single-Gene Disorders
    • Using the polymerase chain reaction (PCR), DNA extracted from the biopsy specimen is used to screen for a known hereditary disorder-for example, cystic fibrosis, muscular dystrophy, and Huntington's disease.
    • Only unaffected preimplantation embryos would be transferred to the woman's uterus.

Obesity of female:


BMI is obtained by dividing the weight (kg) by square of height in meters.


BMI (kg/m2)











Morbidly obese


Waist-to-hip ratio is also helpful in PCOS patients as marker of obesity and hyperinsulinernia.


Waist: Hip


Greater than 0.85

Android obesity

Less than 0.75

Gynoid obesity


Hyperinsulinemia is associated with android obesity.


The waist measurement is the smallest circumference between ribcage and the iliac crests.


The hip measurement is the largest circumference between the waist and the thighs.

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