What is Intrauterine insemination ?
The technique of Intrauterine insemination (IUI) is a widely popular assisted reproductive technique due to its simplicity and affordability. The IUI procedure involves introducing washed and actively motile sperms directly into the uterine cavity (womb), at or around the time of ovulation, with the aim of increasing the chances of pregnancy. The purpose of IUI is to increase the number of active sperms reaching the egg in the fallopian tube, bypassing the vagina and cervix, thus, shortening the distance to be travelled by the sperms.
IUI is a simple procedure and can be performed whether or not the woman is receiving medication for egg formation. However, stimulation of egg development by medication does improve success rates, as more than one egg will develop. Monitoring by USG is essential to track follicular growth and to time the ovulation. Once the follicle reaches maturity, the patient is given hCG injection (human chorionic gonadotropin) for ovulation, which usually takes place within 24 to 36 hours of the injection.
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Who are eligible for IUI procedure?
To consider IUI :
- The female partner should be ovulating normally or should be able to ovulate with medication for ovulation
- She should have open fallopian tubes or at least one fallopian tube should be patent and
- The male partner should have satisfactory sperm counts, motility and morphology
IUI not indicated in following conditions
- Female partner with
– tubal block on both sides
– inability to develop eggs
– age > 40 years
– advanced stages of endometriosis
- Male partner with azoospermia (absence of sperms in semen) or very low scores of sperm count, motility and morphology.
What is the procedure for IUI?
The total procedure has three components. One is semen collection, second is semen preparation and the third is deposition of active sperms in the uterine cavity. The entire procedure takes approximately 1 – 3 hours.
Semen collection and preparation
A short period i.e. 2 days of ejaculatory abstinence is advised prior to the scheduled IUI. At the predicted time of ovulation, the male partner is asked to collect semen into a sterile container and submit it in the laboratory for sperm preparation. Here semen analysis is performed to check for initial parameters. Then it is processed. Best quality active sperms are separated and made into a small quantity (0.25 ml). Rest of the seminal fluid containing dead sperms, bacteria and other components which can cause painful contractions of the uterus, is discarded. Post-wash active sperm count is noted for sample adequacy for insemination. Minimum count of five millions of active sperms is acceptable. Success rates are low with lower counts.
Actual IUI procedure
Once the specimen is ready, the female partner is called for IUI procedure to the insemination room. She is made to lie down on the couch with legs flexed. A speculum is introduced into the vagina to expose the cervix and it is gently cleaned. Prepared sperms are loaded into a slender semi flexible sterile catheter with a plunger. It is then passed through the cervix into the uterine cavity and the sperms are injected by pushing the plunger.
How much time does the actual IUI take and will it cause any pain?
Actual IUI (deposition of active sperms into the uterus) procedure takes only a couple of minutes. The procedure is usually painless, although 10% of the women may experience a menstrual cramp like pain. There may be a little vaginal spotting or discharge after IUI.
Is rest necessary after IUI?
The female partner will be asked to lie down for a few minutes after IUI (10 – 15 minutes). Then she can resume her regular activities. The sperms will not escape from the uterine cavity if she gets up.
Is intercourse advised after IUI ?
Yes, this will increase the chances of conception.
How many sittings of IUI are performed in one cycle?
Usually one single properly timed insemination is sufficient.
How many cycles of IUI are recommended?
Four to six cycles of IUI may be tried as there is no improved success seen later.
Chances of success with IUI
Average success rate ranges from 15-20 % in a single cycle. The success rates may be high in stimulated cycles and if the total sperm count is more than 20 million/ml.
What are the risks involved with IUI?
Procedure related complications are infrequent. They include infection where women can suffer with lower abdominal pain, vaginal discharge.