ovarian follicles by the administration of medications such as preparations of exogenous

gonadotropins or clomiphene citrate.

‚ Human Menopausal Gonadotropins: preparations of exogenous gonadotropins (FSH and

LH) used to stimulate ovarian follicle development.

ƒ Intrauterine Insemination: the delivery of sperm to the uterine cavity.

„ Multifetal Pregnancy: the development of more than one fetus.

… Subfertility : impaired cycle fecundity.

† Superovulation: the development of multiple ovarian follicles and the release of multiple

oocytes.

k AID: (Artificial Insemination by Donor)

v The combined use of COH and IUI may have a synergistic effect on pregnancy rates.

v Techniques:

P Pre-therapy evaluation:

Semen analysis, HSG or hysteroscopy to detect uterine anomalies, laparoscopy for

detection of potential or tubal factors of infertility, and a midluteal serum

progesterone assay and/or endometrial biopsy.

P Candidates for therapy:

Couples who were infertile for at least 1 year, who were ovulatory and had a regular

menstrual interval of less than 35 days, and who had at least one tube without a

mechanical barrier to oocyte capture.

P Ovarian Stimulation:

1. Women receive HMG (150-225 IU/day) intramuscularly beginning on cycle day 2 or 3. ( The selection of the initial dosage was dependent on the weight and age of the woman as well as on her prior experience with superovulation regimens.)
2. On cycle day 5 or 6, ultrasound evaluation of the pelvis and measurements of serum estradiol concentrations were begun and repeated every 1 to 3 days.
3. When the leading ovarian follicle had reached preovulatory size, hCG 5000 IU was given intramuscularly.
4. The luteal phase was supplemented with two additional injections of hCG (2500 IU intramuscularly).

· . The effect of using adjunctive leuprolide therapy is still to be determined.

ž MMH Experience (Chief Lee):

Principles: Adjust dosage individualizedly to meet the optimal condition

on which at least 3 follicles in size of 1.8 mm or more on D_12±

? Intermediate Responders:

HMG/FSH: 2 ampules/day since D₃ to the previous day of hCG injection

‚ Strategy for Possible High Responders:

(eg. Young, PCOD, anovulation, etc.)

ð Reduce HMG/FSH dose: 1 amples/day initially, then adjust accordingly

P IUI: done 38 to 40 hours after the initial injection of hCG.

¹ Cycle Fecundity: (1985-1992, Pennsylavania State University, Hershey Medical Center, 773 Couples)

j Cycle Fecundity by Diagnosis:

k Cycle Fecundity by Attempt:

m Cycle Fecundity by Number of Follicles 17mm on the Day of hCG Injection:

n Cycle Fecundity by Woman’s Age:

o Cycle Fecundity by Number of Motile Sperm in the Inseminate:

¹ Complications:

j Ovarian Hyperstimulation Syndrome:

- Incidence: similar to that in ART

k Pelvic Infection

　

¹ Pregnancy-Associated Complications:

j Spontaneous Abortion:

- Incidence: abaout 20%

1. Reproductive Endocrinology, Surgery, and Technology; Adashi, Rock, and Rosenwaks; 1996.

Filename: IUI