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Intrauterine insemination more popularly known by its abbreviation IUI is a procedure where semen is processed after collection in lab and then this is inserted via a small catheter inside the uterus.
IUI is done for many reasons some of them could be due to problems in coitus , sexual dysfunction mild male subfertility ( counts less than 15 million /ml/) , anatomical problems in male like hyo spadiasis or epispadiasis , PCOS , mild endometriosis and serology positive couple etc
IUI can be done in natural cycle or in a stimulated cycle. The preparation starts with few medicines for ovulation induction mainly letrozole or clomiphene on day 2 or 3 of the menstrual cycle after a baseline USG . There would be another USG to see the growth of follicle and additional injections might be added to the same. Trigger injection for follicular rupture is given when follicle grows to a size of 1.7 to 1.8.
IUI is then planned accordingly after 24 or 36 or 48 hours after confirming ovulation on USG. IUI can be done on a single sitting or 2 times in the same cycle . This depends on the follicular rupture time and also on the semen report of the partner. IUI success rates are between 15 to 20 % per cycle .
The ovaries are stimulated with medication to promote the growth of follicles and this can be done by using both Tablets and Injections.
There are many different types of stimulation Treatments
Natural Cycle Insemination - This option doesn’t involve any medication and follows the women's natural menstrual cycle. This usually has low success rate.
Clomiphene Citrate Ovulation Induction - This option involves the use of medication in the form of tablets to stimulate the ovaries.
Gonadotrophin injection - This option involves the use of hormone injections to stimulate the follicles in the ovaries.
The response of ovaries to the injections and medications can be monitored by doing serial Ultrasound scans.
Ovulation Trigger: To assist with the final maturation of the egg from the follicle, an injection of Human Chorionic Gonadotrophin (HCG) may be given. This ensures maturation and release of the egg from the follicle.
Using Partner's Sperm (Fresh Sperm) - An Abstinence of at least 3 days but not more than 5 days is required to collect an optimal sample for the processing of the IUI. The Sperm sample is analysed and processed to concentrate the motile sperm and remove debris and immotile sperm.
Donor Insemination (Frozen Sperm) - In this procedure the Sperm sample is obtained from Semen Bank.
A concentrated washed sample of motile sperm is used for insemination. The final sample is gently inserted into the uterine cavity using a speculum and a disposable catheter to bypass the cervix. The insemination procedure is simple and usually painless and takes few minutes.
Pregnancy test is performed two weeks after the insemination.
In Normal Intercourse only about 15% of ejaculated sperm succeed in passing through the cervix. The mucous barrier that exists in the cervix reduces the number of sperm that can pass into the uterus and fallopian tubes following normal sexual intercourse. Where the male already has a reduction in sperm count and/or morphology, and/or its motility, this normal barrier reduces the yield of fertile sperm even further.
The Success rates of IUI varies depending on multiple factors. The range is from 10% to 12% per cycle.
Artificial Insemination is recommended for couples experiencing any of the following:
Unexplained infertility - (Documented ovulation, patent tubes and Normal semen analysis)
Ovulatory disorder responsive to fertility medication.
Problems with intercourse like Erectile Dysfunction, but potentially normal sperm production.
Male partner is absent for long periods- sperm may be frozen
Hostile cervical mucus
IUI can also be recommended in cases where a woman or couple needs donor sperm.
Donor sperm is needed in cases where the husband/partner:
Is azoospermia (no sperm produced in Semen).
Is a carrier of a hereditary disease.
Is unable to produce sperm.
Artificial Insemination or IUI treatment is not recommended for:
Women over 38 years of age.
Women with tubal blockage or severe tubal damage.
Women with severe endometriosis.
Cases where the male partner has a markedly abnormal semen analysis
Overstimulation - Some women may experience an excessive response by their ovaries to the fertility drugs. Ovarian hyperstimulation syndrome (OHSS) occurs in a minority of women who over-respond. Symptoms include severe discomfort, nausea, vomiting, abdominal distension and dehydration. It is important that you notify the clinic immediately if any of these symptoms occur during your treatment, as hospitalisation may be required.
Multiple pregnancy - If there are too many follicles seen on ultrasound before the IUI is carried out, the risk of multiple pregnancy may be too high and the procedure may be cancelled.
Failed procedure - In a small number of cases, it is not possible to place the catheter into position through the cervix, and the sperm cannot be inserted into the uterine cavity.