Tuesday, April 24, 2007

YouTube - Happy birthday

YouTube - Happy birthday: "http://www.youtube.com/watch?v=q2tQuf10BRA"

Sunday, April 8, 2007

Kangaroo Care: Why Does It Work?

Kangaroo Care: Why Does It Work?
By the early 1980s, the mortality rate for premature infants in Bogota, Colombia was 70 percent. The babies were dying of infections and respiratory problems as well as lack of attention paid to them by a bonded parent. "Kangaroo care" for these infants evolved out of necessity. Mothers of premature infants were given their babies to hold twenty-four hours a day-they slept with them and tucked them under their clothing as if in a kangaroo's pouch. If a baby needed oxygen, it was administered under an oxygen hood placed on the mother's chest.
Doctors who conducted a concurrent study of the kangaroo care noticed a precipitous drop in neonatal mortality. Babies were not only surviving, they were thriving. Currently in Bogota, babies who are born as early as ten weeks before their due date are going home within twenty-four hours! The criteria for these babies is that they be alive, able to breathe on their own, are pink and able to suck. However, their weight is followed closely, and they can be gavage-fed if necessary.
Dr. Susan Ludington is one of the people who have been most instrumental in bringing kangaroo care to the United States. She has been intimately involved in many research projects, and her work is having a powerful, positive impact on premature babies and their families. In the United States, the few hospitals that regularly use kangaroo care protocols have mothers or fathers "wear" their babies for two to three hours per day, skin-to-skin. The baby is naked except for a diaper, and something must cover his or her back—either the parent's clothing or a receiving blanket folded in fourths. The baby is in a mostly upright position against the parent's chest.
The benefits of kangaroo care are numerous: The baby has a stable heart rate (no bradycardia), more regular breathing (a 75 percent decrease in apneic episodes), improved oxygen saturation levels, no cold stress, longer periods of sleep, more rapid weight gain, more rapid brain development, reduction of "purposeless" activity, decreased crying, longer periods of alertness, more successful breastfeeding episodes, and earlier hospital discharge. Benefits to the parents include "closure" over having a baby in NICU; feeling close to their babies (earlier bonding); having confidence that they can care for their baby, even better than hospital staff; gaining confidence that their baby is well cared for; and feeling in control—not to mention significantly decreased cost!
Why does kangaroo care work? Why are Dr. Ludington and others seeing such phenomenal results with babies in kangaroo care? What is happening to the baby and the mother during this time?
One of the first things to happen is that maintenance of the baby's body temperature begins to depend on the mother, requiring the baby to use fewer calories to stay warm. Mothers naturally modulate the warmth of their breasts to keep their infants at the optimal temperature where babies sleep best, have the best oxygen saturation levels, the least caloric expenditure, and so forth. Maternal breast temperature can rise rapidly, then fall off as baby is warmed. As the baby starts to cool, the breasts heat up again—as much as 2 degrees C in two minutes!
Being next to morn also helps the baby regulate his or her respiratory and heart rates. Babies experience significantly less bradycardia and often, none at all. The respiratory rate of kangarooed infants becomes more stable. The depth of each breath becomes more even, and apnea decreases four-fold and often disappears altogether. If apneic episodes do occur, the length of each episode decreases. In my own experience with a baby in NICU for bradycardia and apnea, I found that both problems disappeared completely when I was home kangarooing my baby.
During kangaroo care, a premature baby's overall growth rate increases. This is in part due to the baby's ability to sleep, thus conserving energy and putting caloric expenditure toward growth. According to Dr. Ludington, during the last six weeks of pregnancy, babies sleep twenty to twenty-two hours per day. In a typical NICU, however, they spend less than two hours total in deep, quiet sleep. Most of that comes in ten or twenty second snatches. With kangaroo care, the infant typically snuggles into the breast and is deeply asleep within just a few minutes. These babies gain weight faster than their non-kangarooed counterparts, and it is interesting to note that they usually do not lose any of their birthweight.
Researchers have gained significant insight into what happens to an infant's brain during kangaroo care. Any baby's heart rate and respiratory rates can be plotted as a sort of artistic drawing. Because premature infants lack the ability to coordinate their breathing and heart rates, the rates "plot out" as chaotic. This means with increased demand on the cardiovascular system, as with crying or fussing, the system does not respond with a related increase in cardiac output. In other words, the baby's respiratory rate may increase while crying, but the heart rate does not. As premies mature, these rates become synchronized, or "coupled," resulting in an orderly drawing when the rates are plotted together. The drawing no longer looks random.
In infants in kangaroo care, researchers found that coupling takes place after only ten minutes. This hardly seemed possible because it equaled four weeks of brain development in the "normal" premie. As researchers studied brain wave patterns of infants in kangaroo care, they found two significant things. First, there was a doubling of alpha waves—the brain wave pattern associated with contentment and bliss. Second, they found that "delta brushes" were occurring. Delta brushes happen only when new synapses are being formed. So holding the infant skin-to-skin allows his or her brain to continue its work of developing neural synapses.
Imagine the implications if all infants "at risk" were kangarooed. Dr. Ludington sums up kangaroo care very aptly by saying "Separation is not biologically normal."
Helping our clients understand their options, including risks, benefits and alternatives, is a very important part of being "with woman." Knowing enough about kangaroo care to help them make informed decisions is another important tool for the caregiver's birth bag. All infants benefit from skin-to-skin contact, breastfeeding, shared sleep and so forth, but some babies very seriously need kangaroo care. They include premature infants, infants with low muscle tone or disabilities, high-needs infants, those with intrauterine growth retardation or those who have a hard time gaining weight. Midwives would do well to learn the basics of kangaroo care, and where to turn for further information. Adding Dr. Ludington's book Kangaroo Care to one's library is a good first step. Being supportive of parents and giving encouragement and positive reinforcement is also very helpful. Remember that in some instances, kangaroo care has meant the difference between life and death.
Close Contact
How Kangaroo Care Can Help Your Preemie
By Lyn Mettler
Most new parents get to bond with their babies immediately after birth, but according to experts, 7 percent of all babies are born premature, and those parents may have to wait weeks before ever holding their baby. Thanks to a technique called "Kangaroo Care," however, parents of premature babies are getting to hold their newborns much sooner – and help their little ones at the same time.
Krisanne and Gene Larimer of Colorado Springs, Colo., only had to wait five days before holding their baby girl who weighed just over a pound at birth. Krisanne nervously tried touching her baby, only to be discouraged by alarms alerting nurses to a problem with the baby’s heart. When she tried Kangaroo Care, with the baby skin-to-skin on her chest, it was a different story. "Every time I’d touched her before that, her alarms would just sound," says Larimer. "With Kangaroo Care, there were no alarms. I felt like a mom for the first time then."
Kangaroo Care allows moms and dads to hold their babies, wearing only diapers, on their bare chest up to several times a day. This skin-to-skin contact has numerous benefits, both emotional and physical, for both the baby and parents. "We mammals have been doing this for eons," says Theresa Kledzik, an infant development nurse specialist at Memorial Hospital in Colorado Springs, Colo. "It seems like a natural instinct thing to do."
Healthy Benefits for BabyDoctors in Bogotá, Colombia developed the technique in 1983 in response to the number of premature babies dying at their hospital. Because the facility had unreliable equipment and power, the doctors decided to see if the babies would do better with their moms. The women carried their babies around all the time on their bare chests – under their shirts, in their bras or in specially-designed pouches (thus the term "kangaroo"). Through Kangaroo Care, the doctors were able to decrease the mortality rate from 70 percent to 30 percent.
After these findings, the world began to take note and do further research on Kangaroo Care. The idea first spread through Europe, and then in 1988, Susan Ludington, currently a professor at the University of Maryland School of Nursing, began doing studies in the U.S. Now hospitals across the country and the world are offering Kangaroo Care, and countless research studies have documented the benefits.
Placing babies on bare skin helps keep them warm, a task that is difficult for premature babies who have not yet developed the layer of fat that full-term babies have. Moms also seem to have an innate way of adjusting their body temperature to meet the baby’s needs. For example, if Baby gets too hot, Mom will cool down and vice versa. Ludington, also the author of Kangaroo Care: The Best Thing You Can Do to Help Your Preterm Infant, says Kangaroo Care helps the baby develop a regular heart rate and breathing pattern. It also reduces periods of apnea, when babies stop breathing, and increases oxygen in the blood.
Babies in Kangaroo Care also grow and gain weight more quickly. Studies have found that they go to sleep twice as often, get more restful sleep and are more alert, relaxed and calm when they are awake. Kangaroo Care often enables babies to go home from the hospital earlier, saving much wear and tear on parents who may have already spent days or weeks with their babies in the stressful neonatal intensive care unit (NICU).
Skin-to-skin Stress Relief for Mom and DadKangaroo Care also can help reduce some of the stress of the NICU for both parents and babies, as well as the fear and nervousness parents may feel about handling their baby. "It is a very stressful environment for parents," says Dr. Scott Johnson, the medical director of neonatal services at Piedmont Hospital in Atlanta, Ga. "They feel helpless and are worried about the baby’s medical condition. It’s intimidating. Some are even scared to death to touch them. I’ve seen [Kangaroo Care] greatly decrease the level of anxiety they feel in visiting their baby. It allows them to gradually get more comfortable and feel better caring for the baby, easing the transition from hospital to home."
Larimer says she was afraid to hold her own baby, but overcame the fear quickly. "I was scared to death to hold her. I couldn’t breathe for the first few minutes," says Larimer, who advises parents to give it a try despite their reservations. "Even though you’re scared to death to try it, it’s the best feeling you’ll ever have." Larimer has developed a free booklet for parents of premature babies who may be scared or unsure about Kangaroo Care that is available through her Web site at www.geocities.com/roopage.
Researchers have found that babies receive the same benefits by "kangarooing" with their dad as they do with their mom. According to Ludington, though, the baby is naturally immune to Mom’s germs – but not to Dad’s, so fathers need to "scrub up" before holding the baby.
With twin boys born at 28 weeks, Matthew and Suzanne Howard of Smyrna, Ga., were nervous about Kangaroo Care, but they worked it out so each held a baby. Though Matthew was unsure about holding the babies at first because they were so tiny, once he laid them on his chest, he was hooked. "When we got to hold them, it was incredible," he says. "They would snuggle right up on my chest. It was really sweet."
Practicing Kangaroo CareIn a typical Kangaroo Care session, the mother or father relaxes in a chair while the nurses slowly transfer the baby, still attached to any tubes or cords, from the bed onto the parent’s bare chest. Screens are usually provided for privacy. Once the baby is settled, the nurse will either place a blanket over the baby’s back or help the parent button their shirt around the baby. Sessions usually last from 30 minutes to two hours and are typically done twice a day.
Not all hospitals use Kangaroo Care, so parents interested in the technique should check with their local hospitals to find out if it is an option. For parents whose hospitals don’t offer Kangaroo Care, Kledzik suggests trying to find a nurse or other staff person who is sympathetic to the idea. "A lot of nurses have heard about it, and if they have a mother that’s begging for it to happen, they may attempt to accommodate her on their shift," she says.
When Larimer was pregnant with her second child, it was critical to her that the hospital where she would deliver allow Kangaroo Care. She and her husband passed up a major job promotion for him because they would have had to move to a city where no hospitals offered it. Larimer hopes that one day all hospitals will see the benefits of Kangaroo Care and implement a program in their NICUs.
"There’s no downside to doing this or at least trying it," says Dr. Johnson. "There are many small stories of how amazed parents are. Just the look of amazement and excitement on their face when they do it and the happiness it provides parents is what I remember most."
Kangarooing Tips In her book, Kangaroo Care: The Best Thing You Can Do To Help Your Preterm Infant, Susan Ludington offers several tips for a successful kangarooing session. Here are just a few:
Select a time after a feeding. If breastfeeding, moms may feed their baby during the session.
Make sure the room temperature is between 70 to 72 degrees Fahrenheit and stay away from drafts.
Use a wide, reclining chair (if available) with good padding or bring a pillow along.
Wear clothing that is easily adjustable when positioning the baby.
Moms who are six weeks or less postpartum should stand up every hour to hour and a half for several minutes.
Try to "kangaroo" for at least an hour.
During Kangaroo Care, also known as skin-to-skin care, the baby is placed on the parent's chest, clad only in a diaper and cap. The baby's head is turned to the side so that it's ear is against the parent's heart. Vent tubing and wires are taped to the parent's gown. Usually, two nurses assist in the transfer from warming bed or isolet to the parent's chest. This process can take just 10 minutes, even with a vented baby. Kangaroo Care can also benefit older preemies and full-term babies.
The name Kangaroo Care is used because the method is similar to how a baby kangaroo is carried by its mother. Kangaroo Care originated in Bogota, Columbia in 1983 by Neos Edgar Rey and Hector Martinez when they developed the "Kangaroo Mother Care" program to decrease the high mortality rate among preemies. Moms carried their preemies in slings all day, every day and the mortality rate fell from 70% to 30%. According to Katie Brietbach, R.N.C., N.C., of the Pediatric Nursing Division at the University of Iowa Hospitals & Clinics, Kangaroo Care began in South America, where premature babies were sent home snuggled between their mothers’ breasts, being fed only breastmilk. The method spread to countries in Europe and then to the United States, where an estimated 200 neonatal intensive-care units practice kangaroo care, up from about 70 in the early 1990s. Kangaroo care is often used with premature babies because the close contact with the parent can stabilize the baby’s heartbeat, temperature and breathing. Premature babies have a hard time coordinating their breathing and heart rates (often called coupling). As the baby’s heart rate increases, there could be an increase of apnea, which is a temporary loss of breathing. Studies have shown and many medical professionals agree that kangaroo care can help the baby better coordinate its breathing and heart rate. However, some doctors believe premature babies are too fragile to be held, and that close contact with parents can increase the risk of infection. Studies to date have shown only positive results of Kangaroo Care. Unfortunately some hospitals still don't allow any form of Kangaroo Care or holding. Some allow Kangaroo Care only when the baby is 'stable' or off all breathing machines. But, there are a few that realize that Kangaroo Care is the best thing a parent can do for their baby! Mothers who use kangaroo care can have more success with breastfeeding and improve their milk supply. Premature babies (particularly those less than 34 weeks gestational age) often suck better at the breast than the bottle, because premature babies are usually not able to control the flow of milk from a bottle. At the breast, preemies can coordinate the suck, swallow, breath sequence better. Susan Ludington, a professor of maternal and child health nursing at the University of Maryland at Baltimore and author of "Kangaroo Care: The Best You Can Do for Your Premature Infant," has conducted several studies on kangaroo care. Her research has found that Kangaroo Care conserves a baby’s energy and increases milk production in mothers. Kangaroo Care can also boost a premature baby’s brain development, according to Ludington. She has found that for a 30-week-old preemie, a 10-minute session of close contact with a parent can increase the fusion of the preemie’s brain cells. Researchers from Case Western Reserve University in Cleveland conducted a case study in which a mother with ECLAMPSIA practiced Kangaroo Care with her premature baby in order to breastfeed. Because of the mother's condition, the Kangaroo Care sessions were closely monitored by medical professionals. The study showed that kangaroo care allowed the mother to successfully nurse.
Kangaroo Care : Close cuddling helps premature babies develop produced by Gregg Bakerreported by Lucky Seversonstory by Shawn O’Learyvideo edited by Katie Elfsten
Every year in the United States, over 400,000 babies are born prematurely or at a low birth weight. Typically a premature baby is whisked away at birth from its mother and hooked up to hi-tech intensive care machines that control breathing and other vital functions. But the most powerful therapy may be old-fashioned, low-tech snuggling that neo-natal experts call kangaroo care.
FREE RIDEA baby kangaroo doesn’t start hopping around in the open world until it has spent some five months in its mother’s pouch where it breastfeeds, sleeps, and otherwise gets a free ride. During these 180 days, the senses and size of the joey, as it’s called, grow so that is better able to survive on the outside.
BACK TO THE WOMBIn the 1980’s doctors found that this style of nurturing can significantly help premature human babies grow. Kangaroo care requires a parent to hold the baby chest to chest and skin to skin a few hours a day for several weeks until the infant is out of danger and well on the path of normal development.
Neonatologist Dr. David Golembeski, MD of Palomar Medical Center in Escondido, CA points out that in study after study, this simple bonding tends to significantly improve a “preemie’s” fragile health. “Part of the philosophy is to try and put them back into the uterus, to let them feel the mother’s breathing and heartbeat, to control their temperature,” says Golembeski. “Babies have fewer days on the ventilators, fewer days on oxygen, go home sooner, and have less complicated courses in the hospital if we simply let parents be involved, bond with their babies, and let them do this kind of holding.”
IMMUNE SYSTEM STRENGTHENINGBabies treated with kangaroo care also tend to overcome their breast feeding problems which allows them immunity enhancement from their mother’s milk and mother-child bonding. “I see breast feeding as another example of it where you get a closeness not only to food, but to your mother, to skin, to warmth,” says Dr. Golembeski.
Little Michael Zimmerman is catching up after six weeks in the neo-natal intensive care unit. He was born almost eight weeks early, weighing just three pounds. His mother Laura was asked to hold him more and more as the weeks went by, as he became stronger. “I’d go in in my gown and I’d just uncover it and they’d just put him against my chest,” she recounts. “He’d hardly move or cry; he’d just fall asleep. I remember it being very difficult because he was connected to IV lines and feeding tubes. I was just crying.”
Dr. Nancy Wight, MD neonatologist at Sharp Community Health Group in San Diego is convinced that a combination of hi-tech and kangaroo care works wonders on intensive care preemies like Michael: “They’re doing everything,” says Wight. “They are catching up a lot quicker than they would otherwise. The mother’s body temperature self-regulates and adjust to the baby’s temperature. If the baby cools down, the mother heats up, and vice versa.”
HOME AT LASTAfter several weeks Michael and Laura were spending up to half a day together. “Everyone needs to be held and touched. He had no significant medical problems. And it was a matter of him growing big enough in the hospital to be released.”
Now that Michael is home, he is gaining weight rapidly, enthusiastically breastfeeding, and breathing with healthy newborn lungs, thanks to his mother’s touch. Laura feels the entire experience has been emotional but has made them closer: “My husband tells me, ‘You’re going to spoil him,’” says Laura. “Yes I spoil him. I carry him with me constantly. We have the little front carrier. He’s tiny, he’s tinier than a regular term baby would be, and I just feel like he needs me.”
BENEFITS FOR ALLNot a problem, says Dr. Wight. Kangaroo-style bonding helps healthy babies too, promoting breastfeeding, alleviating stress, and stimulating development. “You have children who are more independent, more self-sufficient, less fearful if you establish a trust right at the beginning,” she says. “Hold your child. Be with your child as much as possible.
Dr. Wight admits doctors don’t always have all the answers: “It’s hard to get neonatologists, pediatricians, obstetricians, and other really intensive docs to back off a little bit and see what Mother Nature has to offer.”

A Code of Ethical Behavior for Patients

DO NOT EXPECT YOUR DOCTOR TO SHARE YOUR DISCOMFORTInvolvement with the patient's suffering might cause him to lose valuable scientific objectivity.
BE CHEERFUL AT ALL TIMESYour doctor leads a busy and trying life and requires all the gentleness and reassurance he can get.
TRY TO SUFFER FROM THE DISEASE FOR WHICH YOU ARE BEING TREATEDRemember that your doctor has a professional reputation to uphold.
DO NOT COMPLAIN IF THE TREATMENT FAILS TO BRING RELIEFYou must believe that your doctor has achieved a deep insight into the true nature of your illness, which transcends any mere permanent disability you may have experienced.
NEVER ASK YOUR DOCTOR TO EXPLAIN WHAT HE IS DOING OR WHY HE IS DOING ITIt is presumptuous to assume that such profound matters could be explained in terms that you would understand.
SUBMIT TO NOVEL EXPERIMENTAL TREATMENT READILYThough the surgery may not benefit you directly, the resulting research paper will surely be of widespread interest.
PAY YOUR MEDICAL BILLS PROMPTLY AND WILLINGLYYou should consider it a privilege to contribute, however modestly, to the well-being of physicians and other humanitarians.
DO NOT SUFFER FROM AILMENTS THAT YOU CANNOT AFFORDIt is sheer arrogance to contract illnesses that are beyond your means.
NEVER REVEAL ANY OF THE SHORTCOMINGS THAT HAVE COME TO LIGHT IN THE COURSE OF TREATMENT BY YOUR DOCTORThe patient-doctor relationship is a privileged one, and you have a sacred duty to protect him from exposure.
NEVER DIE WHILE IN YOUR DOCTOR'S PRESENCE OR UNDER HIS DIRECT CAREThis will only cause him needless inconvenience and embarrassment. A Code of Ethical Behavior for Patients
DO NOT EXPECT YOUR DOCTOR TO SHARE YOUR DISCOMFORTInvolvement with the patient's suffering might cause him to lose valuable scientific objectivity.
BE CHEERFUL AT ALL TIMESYour doctor leads a busy and trying life and requires all the gentleness and reassurance he can get.
TRY TO SUFFER FROM THE DISEASE FOR WHICH YOU ARE BEING TREATEDRemember that your doctor has a professional reputation to uphold.
DO NOT COMPLAIN IF THE TREATMENT FAILS TO BRING RELIEFYou must believe that your doctor has achieved a deep insight into the true nature of your illness, which transcends any mere permanent disability you may have experienced.
NEVER ASK YOUR DOCTOR TO EXPLAIN WHAT HE IS DOING OR WHY HE IS DOING ITIt is presumptuous to assume that such profound matters could be explained in terms that you would understand.
SUBMIT TO NOVEL EXPERIMENTAL TREATMENT READILYThough the surgery may not benefit you directly, the resulting research paper will surely be of widespread interest.
PAY YOUR MEDICAL BILLS PROMPTLY AND WILLINGLYYou should consider it a privilege to contribute, however modestly, to the well-being of physicians and other humanitarians.
DO NOT SUFFER FROM AILMENTS THAT YOU CANNOT AFFORDIt is sheer arrogance to contract illnesses that are beyond your means.
NEVER REVEAL ANY OF THE SHORTCOMINGS THAT HAVE COME TO LIGHT IN THE COURSE OF TREATMENT BY YOUR DOCTORThe patient-doctor relationship is a privileged one, and you have a sacred duty to protect him from exposure.
NEVER DIE WHILE IN YOUR DOCTOR'S PRESENCE OR UNDER HIS DIRECT CAREThis will only cause him needless inconvenience and embarrassment.


Female Infertility
Requirements For Conception to Occur:
In both sexes-
A normal functioning reproductive system
An adequate sex drive, and full sexual intercourse
In Women
A regular ovulatory cycle.
Fully functioning fallopian tubes.
The production of watery mucus by the cervix around the time of ovulation, this permits the ejaculated sperm to pass into the uterus from the vagina.
A uterus which permits implantation of the embryo.
In Men
Producing semen which contains sufficient numbers of healthy motile sperm.
The ability to achieve erection and ejaculate semen into the vagina.
Normal Cycle
At the beginning of the menstrual cycle the pituitary gland in your brain releases follicle - stimulating hormone (FSH) which stimulates the ovary to produce follicles. One of these follicles grows faster to become the " dominant follicle". It is from this follicle that the egg will be released.
The ovaries also produce many hormones, the most important ones are oestrogen and progesterone. Oestrogen promotes growth of the follicles and development of the endometrium, while progesterone, which is released after ovulation, is important in preparing the endometrium for pregnancy.
When the egg is released, it is swept into the fallopian tube, then begins to move slowly down the tube to be fertilised in the outer third of the fallopian tube, and then continues to the uterus to implant in the lining ( endometruim ) resulting in a pregnancy. If the egg is not fertilised, the endometium is shed as a menstrual period approximately 14 days after ovulation.
Common Causes of Infertility in the Female:
Ovulatory disorders
This occurs as a result of hormonal imbalance either within the hypothalamus, the pituitary or in the ovaries. Common causes of this includes stress, excessive weight loss or weight gain, and polycystic ovaries. Polycystic ovaries (POC) can affect up to 30% of women with infertility problems. The ovaries contain many tiny cysts and although the majority of women with PCO have normal regular cycles and have no problems conceiving, others may experience menstrual irregularities, fertility problems, excessive growth of body hair, acne and obesity. Treatment usually involves the use of drugs to correct the hormonal imbalance and stimulation of the ovaries. Alternatively, laparoscopic ovarian drilling using diathermy or laser may be performed.
Fallopian Tube Blockage
May occur as a result of previous infection or abdominal surgery complicated by adhesions. Fluids collecting in the tube (hydrosalpinx) may become a potential source of chronic infection and may also be detrimental for the development and implantation of the embryos. Some blockages can be treated surgically; otherwise IVF treatment might be the best option
Is a condition where the tissue, which normally lines the uterus, is found at other sites in the pelvis. Bleeding occurs from these tissues at the time of menstruation causing pelvic pain and painful periods. Blood filled cysts may develop within the ovaries (chocolate cysts) also pelvic scarring may affect the motility or the patency of the fallopian tubes leading to infertility.
Treatment of endometriosis is either medical using drug therapy or surgical treatment either laparoscopically or by open surgery depending on the extent of the disease. IVF is an appropriate treatment for infertility associated with endometriosis where other methods have failed.
Cervical Factors
Some women have antisperm antibodies within their cervical mucus or produce very little unfavorable mucus at the time of ovulation which interferes with sperm migration through the cervical canal. Hostile mucus may be by passed by intrauterine insemination with or without superovulation.
Unexplained Infertility
Affects 20 - 25% of infertile couples, caused by factors which cannot be assessed by using conventional tests. It is not always possible to determine if, the eggs are actually released from the follicles, if the fallopian tubes are able to pick up the egg, if the sperm is capable of reaching the site of fertilisation and fertilising the egg. Intrauterine insemination using washed sperm suspended in culture medium combined with ovarian stimulation offers a simple relatively non-invasive procedure. If pregnancy does not occur within the three cycles alternative methods such as IVF should be considered which will be both diagnostic and hopefully therapeutic.


Q: What is an IUI and how is it done?
A: An IUI -- intrauterine insemination -- is performed by threading a very thin flexible catheter through the cervix and injecting washed sperm directly into the uterus. The whole process doesn't take very long — it usually only requires the insertion of a speculum and then the catheter, a process that maybe takes a couple of minutes (60-90 seconds to introduce the catheter, then sperm injection, and another 60 seconds or so to remove the catheter — going slowly helps reduce discomfort). Sometimes when the cervix is hard to reach a tenaculum is used to hold the cervix, which makes the process a bit more uncomfortable. A typical "Tomcat" catheter is shown below.

Q: Where is the sperm collected? How long before the IUI?
A: Usually the sample is collected through ejaculation into a sterile collection cup, but it is also possible to obtain collection condoms for this purpose (through the doctor's office -- Milex is one company that makes them). Most clinics want the semen to be delivered within a half hour of ejaculation, around the time of liquefaction, so if one lives close enough the sample can be collected at home. If not, one has to make do with a room at the clinic, a bathroom, or any private setting.
There is a delay between when the semen sample is dropped off for washing and when it is inseminated. The amount of time depends on the washing technique used, which takes 30 minutes to two hours, as well as on the clinic's scheduling. Most will perform the IUI as soon after washing is completed as possible.
Q: When is the best timing for an IUI?
A: Ideally an IUI should be performed within 6 hours either side of ovulation — for male factor infertility some doctors believe after ovulation is better, otherwise chances of success are higher with insemination before ovulation with the sperm waiting for the egg. When timing is based on an hCG injection, the IUIs are usually done between 24 and 48 hours later. Typical timing would be to have a single IUI at about 36 hours post-hCG, though some do it at 24 hours, and some clinics are reporting better results when doing the IUI at 40-42 hours post-hCG. If two IUIs are scheduled, they are usually spaced at least 12 hours apart between 24 and 48 hours after the hCG. Some reports show no increase in success rates with two IUIs, but others suggest it may increase success as much as
6 percent.
Some doctors will base timing of IUI on a natural LH surge. In that case, a single IUI at 36 hours is the norm, but doing them at 24 hours is also pretty common since ovulation may be a bit earlier. When two inseminations are planned, they are usually timed between 12 and 48 hours after the surge is detected.
The egg is only viable for a maximum of 24 hours after it is released.
Q: What is the success rate for IUI?
A: Searching through about a dozen medical journal articles and a number of web sites resulted in a rather wide range of statistics. Basically the odds of success are reported to be just under 6 percent and as high as 26 percent per cycle. The low statistics are with one follicle, while multiple follicles resulted in as high 26 percent success. Another influencing factor is sperm count. Higher sperm counts increase the odds of success; however, there was little difference between success with good-average counts and those with high counts. The overall success rate seems to be between 15-20 percent per cycle, judging from the articles which will be abstracted below. The rate of multiple gestation pregnancies is 23-30 percent.
Q: What does an IUI feel like?
A: Most women consider IUI to be fairly painless -- along the same lines as having a pap smear. There can be some cramping afterward, but often what is felt is ovulation-related rather than from the IUI. The catheter usually doesn't feel like much since the cervix is already slightly open for ovulation -- a poorly timed IUI might cause more discomfort at the cervix. See the
personal experiences below for more details.
Q: How long does washed sperm live?
A: Current research indicates that washed sperm can live 24-72 hours; however, it does lose potency after 24 hours. Another issue with IUI is that the sperm can keep on swimming beyond the fallopian tube, so the ideal window is really within 6-12 hours of the egg being released, with a larger margin before ovulation than after since the egg's viability is shorter. Sperm can live up to 5 days in fertile mucus, 2-3 days being pretty common, so combining IUI with intercourse may provide better coverage.
Q: Do I have to lay down after an IUI?
A: You don't have to lay down because the cervix doesn't remain open, but most doctors let patients lay down on the table for 15-30 minutes after the procedure.
Q: Do I need to take it easy after an IUI?
A: Most people don't need to, but if you had cramping or don't feel well afterward it makes sense to take it easy for awhile. Some people reduce their aerobic activity and heavy lifting during the luteal phase in hopes it will increase the chance of implantation. It is more important to take it easy for a bit after IVF, as that is a more invasive process.
Q: How long before an IUI should the male abstain from intercourse/ejaculating and store up sperm?
A: This depends on your individual situation, but it usually should not be more than than 72 hours since his last ejaculation in order to ensure the best motility and morphology. Where low sperm count is the reason for IUI, it is generally best to wait 48 hours between ejaculation and collecting sperm for the IUI. With no sperm count issues, it makes sense to wait at least 24 hours. Some suggest trying for about 36 hours to cover the most territory with the highest counts — a common suggestion is to have intercourse around the time of hCG injection.
Q: How soon after an IUI can I have intercourse?
A: Usually you can have intercourse anytime after an IUI . . . in fact, most doctors suggest having intercourse, when that is an option, soon after the last IUI to help make sure ovulation is covered. Your doctor may suggest waiting 48 hours to resume relations if you had any bleeding during the IUI or if a tenaculum is used.
Q: Can the sperm fall out?
A: Once the sperm is injected into the uterus, it does not fall out. There can, however, be increased wetness after the procedure because of the catheter loosening mucus in the cervix and allowing it to flow out. Some doctors will insert a cup around the cervix to prevent leakage, but most do not.
Q: How come I feel wetter after the IUI — like the sperm is falling out?
A: The catheter loosens cervical mucus and lets it come out more easily. It is common to see more fertile mucus after an IUI for this reason, as well as the fact that well-timed IUI should be close to ovulation.
Q: How many follicles give my best chance of getting pregnant?
A: According to different studies, either 3-4 follicles gives one the best chance of getting pregnant, while more follicles beyond that simply increases the risk of multiples. The U.S. study said 4 follicles, while other countries have data stating 3. The U.S. has a higher rate of multiple births, so 3 may be more likely to be the correct answer.
Q: Does IUI make sense when there isn't a sperm count problem?
A: IUI can help on Clomid cycles where cervical mucus is a problem, and IUI increases the chance of success on injectable cycles no matter what the sperm count. It does make sense to try IUI if you can and haven't had success with intercourse. It is important to note that with intercourse, only the best and strongest sperm make it through the cervical mucus and up into the uterus and fallopian tubes. With IUI, more sperm will be available for fertilization.
Q: How high a sperm count is needed for IUI?
A: A count above one million washed appears necessary for success, with a significant reduction in pregnancy rates when the inseminated is count is lower than 5-10 million (in other words, in most cases one should consider 5 million a lower limit for success,
10 million for cost-effective). Higher success rates are with washed counts over 20-30 million, while increasing counts over 50 million did not appear to offer advantage. Advanced Fertility has a chart of success rates for one month of various treatments.
Q: How many IUIs should I try before moving on to IVF?
A: It depends on what you can afford and what meds you are doing. One might do 3-4 IUIs on Clomid before moving on to injectables, then do 3-4 cycles on injectables. If one doesn't have success after four good ovulatory cycles on injectables with well-timed IUI, it would be time to consider IVF.
Q: Can IUI be done at home?
A: An IUI shouldn't be done at home without medical supervision because the sperm needs to be washed to prevent infection -- i.e., separated from the semen. A
vaginal insemination can be done at home, but is no more successful than intercourse. Some doctors are willing to instruct on doing ICI (intracervical insemination) at home, but it should not be attempted without being taught proper technique. Getting semen or air into the uterus could be quite dangerous -- perhaps life-threatening. One woman wrote in to say there is a midwife practice in Berkeley, CA, that will do inseminations at the patient's home, so it may be worth asking about.
Q: Is bleeding common after an IUI?
A: It doesn't usually happen, but it isn't uncommon. It is most common to have some bleeding if the doctor had trouble reaching the cervix. Some women also have light bleeding with ovulation.
Q: How long after IUI should implantation occur?
A: Implantation generally takes place 6-12 days after ovulation — so 6-12 days after a well-timed IUI. See
Q: How much does IUI cost?
A; This is definitely something to consult your doctor or clinic about as the price varies considerably. Ask for a rate sheet, if available, and also ask what your cycle is likely to entail. The IUI procedure and sperm washing average Rs 2000-5000 but the cost of medications, ultrasounds and bloodwork can make a considerable difference. Someone doing a natural IUI cycle may spend only 2000, while someone on injectable medications with monitoring may spend Rs 5,000-9,000.
Q: What kind of monitoring is usually done for an IUI cycle?
A; This depends mostly on how the female is being treated. A natural cycle is often timed to over the counter ovulation prediction kits. The use of clomiphene citrate can increase the monitoring, but many doctors don't do ultrasounds or settle for one u/s around cycle day 12. Gonadotropins increase both medication costs and the necessity of ultrasounds and bloodwork.
Q: At what size are follicles considered mature?
A: Many doctors monitor follicle development during IUI cycles. Most trigger when the dominant follicle is within a certain size range. While there is always some difference in doctor preference, the norms are unmedicated 20-24mm, clomiphene citrate 20-24mm, FSH-only meds 17 or 18mm minimum, and FSH+LH would be 16 or 17mm minimum. It is possible for slightly smaller follicles, 14-15mm, to contain a viable egg. Also, follicles continue to grow until they release, usually at a rate of about 1-2 mm per day. A woman may ovulate more than one follicle in a cycle, but the releases will occur within 24 hours. When hCG is not used, only follicles close in size are likely to release. The use of hCG induces ovulation in about 95 percent of women, and will get most mature follicles to rupture.
Q: What should estradiol (E2) level be at time of hCG trigger?
A: The
E2 level should be 200-600pg/ml per 18mm follicle. Some doctors are content with a minimum level of 150, but higher tends to be better.
Q: What are the risks involved in IUI?
Q: The main risks are some discomfort such as cramping, minor injury to the cervix that leads to bleeding or spotting, or introduction of infection (including sexually transmitted disease from the sperm itself — it helps to be sure of the known donor's health, or use carefully monitored frozen specimens). There are also risks of hyperstimulation associated with the use of ovulation induction medications such as clomiphene citrate (low risk) and gonadotropin therapy (higher risk). Proper technique and adequate monitoring reduce risks.
Q: Can I take pain medications before or after the procedure?
A: Most women don't need medication for pain associated with IUI. If there is cramping, it is best to avoid medications such as ibuprofen and naproxen (
NSAIDS), but Tylenol is considered safe (but maybe not that helpful for cramps).
Q: What does "sperm washing" mean?
A: It is sometimes also called sperm preparation or spinning. It is a laboratory technique for separating sperm from semen, and separating motile sperm from non-motile sperm, for use in assisted reproduction (IUI, IVF).
The washing technique for near normal specimens is mixing the ejaculate after liquefaction with the appropriate washing medium followed by centrifugation. (A centrifuge is a machine that separates materials with different densities by spinning them at high speed.) The supernatant is discarded and the sediment (sperm rich fraction) is re-suspended in more washing medium. This process is repeated 2-3 times maximum. In the final wash, the sediment is re-suspended in 0.5 cc of medium, loaded into a syringe and deposited in the uterus.
The "Sperm Rise" or "Swim-up" technique is one in which two to five cc of medium are carefully layered on top of 0.2-0.5 cc of semen. Motile sperm cells "swim-up" into the culture medium. After some time (30-90 minutes) the medium (containing motile sperm cells) is carefully harvested and centrifuged. If necessary, fresh medium is layered on top of the seminal fluid again to harvest more sperm cells.
The discontinuous gradient centrifugation technique utilizes a dense liquid phase to separate sperm cells from seminal fluid and debris. There are different compounds commercially available that may be used. Semen is deposited on top of this fluid and subjected to centrifugation. Motile sperm cells migrate to the bottom of the tube, which are used for IUI after further washing.
Q: How soon after an IUI can I go swimming?
A: Since the vagina doesn't open unless something pushes it, it is OK to swim shortly after your IUI . . . but because of how much one has invested in getting pregnant, it probably makes sense to wait 48 hours after your IUIs to go swimming.
Q: Can IUI work after tubal ligation (having "tubes tied")?
A: No. A tubal ligation is effective birth control because it prevents the sperm and egg from meeting. The process that leads to pregnancy is having an egg released from a follicle in the ovary and then beginning the journey to the uterus through the fallopian tube. Sperm will travel from the vagina, through the cervix, through the uterus, into the tube where fertilization occurs. IUI bypasses the need for the sperm to travel through the cervix, but that's it. It doesn't get the egg to the other side of the obstruction, so fertilization won't take place. The only way to get pregnant after tubal ligation is by having reversal surgery or an assisted reproduction technology that includes egg retrieval, such as in vitro fertilization (IVF).