Intra Uterine Insemination (IUI)
Intrauterine insemination (IUI) is often the first treatment offered to couples facing difficulty in conception. It is a simple procedure wherein good quality prepared sperms are placed in the uterus around the time of ovulation, which is the time when the woman is most fertile. IUI is performed by inserting a very thin flexible catheter through the cervix and washed sperms are directly injected into the uterus. It is a short procedure done in OPD setting without need for any anaesthesia and takes only couple of minutes to perform.
Infertile couples can be advised IUI in following situations.
- Unexplained Infertility
- Anovulatory infertility- The eggs in the female partner do not mature in time. In these cases, the growth of eggs is induced with the help of medicines/injections.
- Mild male factor infertility- Reduced sperm counts in the male partner.
- Sexual dysfunction in either partner- The couple are unable to have intercourse for a variety of reasons e.g. vaginismus (painful intercourse), ejaculatory dysfunction (absence of ejaculation in male partner).
- Azoospermia (absence of sperms in semen)- IUI is done with donor sperm. The donor sperms are obtained from a licenses sperm bank, which follows the medical and regulatory requirements for donor screening in order to eliminate the risk of transmission of infectious diseases. Spermsobtained from a screened donor are frozen and quarantined for six months. The donor is retested for presence of infections before the frozen sperms are released from the sperm bank.
- Cryopreserved sperms- Done when the male partner is not available at the time of ovulation or if the sperms have been preserved prophylactically before some treatment that has negatively affected the sperm formation/ count in the male partner.
- Egg- There should be evidence of a growing follicle in the female partner. This can be tested using either ultrasound or urinary LH kits.
- Sperm-IUI can only be done with a normal or near normal sperm count. ICSI is the treatment of choice in case the sperm count is very low or if the sperms are structurally abnormal/ dysfunctional.
- Patent Fallopian tubes in the female partner- IUI should be done when there is evidence that at least 1 fallopian tube is open and patent. Patency of fallopian tubes can be assessed using Hysterosalpingography & Laparoscopy.
Natural cycle IUI– The cycle is monitored for ovulation using serial ultrasound scans and IUI is performed close to the time of ovulation to maximize the chances of fertilization.
Stimulated cycle IUI– In a stimulated Cycle IUI, fertility medication or injections are given to the female partner to stimulate egg formation and the cycle is closely followed to monitor follicular growth using serial ultrasound scans. If the ultrasound scans indicate optimum egg growth, ovulation is triggered with HCG injection and then IUI is performed at the appropriate time to maximize chances of fertilization.
- IUI is always planned around the time of ovulation in order to maximize the exposure of sperms to the eggs and, hence, maximize the chances of pregnancy.
- Male partner collects semen through masturbation on the day of planned IUI
- Semen is processed in the andrology lab to seperate good and motitle sperms from the seminal fluid. This may take 60-90 minutes.
- Approximately 0.3 -0.5 ml of concentarte having good quality sperms is loaded into a fine cather and is gently inseminated inside the uterus of woman partner
Intrauterine Insemination (IUI) is practically a very simple and safe procedure. Use of medications in stimulated cycle IUI carries minor risks of ovarian hyper stimulation and multiple pregnancies. But in experienced hands and with appropriate use of medications, these risks are well within manageable range.
The maximum pregnancy rate with IUI is reported to be in range of 10-15% with maximum chance of conception within first four IUI cycles. A critical success factor with IUI is availability of good andrology facilities at the treating centre.