Intrauterine insemination (IUI)
Intrauterine insemination (IUI) is placing of sperm into a woman’s uterus around the time of ovulation. This is achieved with a thin flexible tube (catheter) that is passed into the vagina, through the cervix, and into the uterus.
Insemination procedures are the simplest and least expensive methods of assisted reproduction.
No anaesthesia or surgery is needed. In IUI, sperm of the male partner is used. IUI is often combined with superovulation medication to increase the number of available eggs so as to enhance pregnancy rates.
Prior to insemination, the sperm are processed (washed and concentrated). Placing unwashed sperm directly into the uterus can cause severe cramps. Concentration is accomplished by selectively choosing highly active, healthy sperm that are more capable of fertilizing an egg. IUI is done on an outpatient basis with without any use of anaesthesia.
There are registered and approved sperm banks from which donor sperm can be used for couples where the male partner is unable to produce sperm or has an extremely low sperm count or carries a risk of transmittable genetic disease to the offspring.
Highlights of IUI at our centre
- We select our patients very carefully before giving them a trial of IUI.
- The medications that are given for ovarian stimulation are chosen after full consideration of the patient’s profile.
- Every IUI cycle is monitored with help of USG & hormonal testing.
- We do one well-timed single insemination, which reduces the cost of the procedure without affecting the success rate.
- Our unit is a FOGSI approved training centre for training in IUI techniques.
Frequently asked questions on IUI
Which couples benefit from IUI?
IUI is done to enhance the fertility in couples where no definite factor appears to be responsible for couple’s infertility. Investigations of women should confirm that she is ovulating either naturally or with ovulatory drugs, has one or both fallopian tubes open and healthy and has a normal uterine cavity. IUI can also benefit couples with marginally low sperm count and motility.
What is donor Insemination?
Under normal circumstances, IUI uses sperms from the husband. However, in cases of severe male factor infertility where sperm count is zero or has severely abnormal sperms with regard to shape or motility, insemination can be done with screened samples from anonymous donors with consent from the couple. These samples are available at authorized registered semen banks.
Steps of IUI Treatment
- The couple is evaluated by history and thorough investigations to see if they are fit for this procedure.
- Ovulation -inducing drugs are usually started on Day 2 or day 3 of a menstrual cycle. Commonly used oral medicines are clomiphene which is given for 5 days. Injections (gonadotropins) can also be used for ovarian stimulation starting from day 2 or 3 of the cycle. The injectable gonadotropins produce greater number and better quality of eggs which further increase the chances of pregnancy. Since the injections are costly and have to be taken daily, they usually reserved for cases where pregnancy fails to occur on oral drugs.
- Monitoring of cycles is done by ultrasound to see the growth of follicles. Usually 3-4 ultrasounds are done in one treatment cycle. In patients on injections, blood tests (serum estradiol) may also be required.
- When follicles are ready (at least one follicle> 18mm) one injection of Hcg is given to cause the rupture of follicle and release the egg. After this injection, ovulation usually occurs between 36-48 hours.
- After 40-48 hours of Hcg injection, couple is called for the procedure of IUI. Ultrasound of female partner is done to document ovulation. However, IUI can be few hours before or after the ovulation. Fresh semen sample of male partner is collected 2-3 hrs before IUI and then it is washed, prepared and injected on the same day. IUI is performed in the OPD and no admission or bed rest is required. Usually there is no restricted in natural intercourse after the procedure. However, the couple should follow their clinician’s advice regarding any further instructions.
- Pregnancy test can be performed 14 after days with urine pregnancy kit in the morning by the first urine sample or by blood test (Serum Beta Hcg)
Complications of the procedure:
IUI is a very safe treatment and complications are infrequent.
- Brief uterine cramping can occur during or after procedure, which can be relieved by mild analgesics.
- Very rarely, infection can occur. Patients should report back if fever and or severe pain abdomen, vomiting, loose motions occur after the procedure.
- When medicines are used for ovulation, risk of ovarian hyperstimulation and multiple pregnancies also exist. These complications are more with injectable than oral medications.
Success rate of IUI
The success rates of controlled ovarian stimulation and IUI depends upon patient condition and medical history of the patient.