Fertility problems have been on the rise for the past few decades and couples who are finding it hard to conceive are experiencing a wide range of fertility problems. However, some couples can really find a solution to their infertility by using a simple technique known as Intra-Uterine Insemination or IUI. It is a type of artificial insemination, which is a simple, minimally invasive, low cost alternative to IVF and an effective technique for treating infertility when indicated.
What is the concept of IUI?
During the intrauterine insemination procedure, sperms that have been washed and concentrated are placed directly in your uterus around the time the ovary releases one or more eggs to be fertilized. It cuts down on time and distance the sperm has to travel, making it easier to fertilize eggs.
The expected outcome of IUI is for the sperm to swim into the fallopian tube and fertilize the egg, resulting in pregnancy. Depending on the reasons for infertility, IUI can be coordinated with your normal cycle or with fertility medication.
Abnormal urethral opening in men (hypospadias/ epispadias).
Chronic Cervical Disease.
Cervical stenosis or abnormalities: This may be seen in women who have had surgery on their cervix (cryosurgery, cone biopsy, or loop electrosurgical excision procedure [LEEP]).
Congenital anomaly of cervix.
Suboptimal fertility in male partners, like slight decrease in the sperm count or motility or abnormality in sperm size and shape. IUI can overcome some of these problems because preparing sperm for the procedure helps separate highly motile normal sperm from lower quality sperms.
Anovulatory cycles: In such cases fertility medications are given to induce the ovulation.
In case of donor IUI where the husband is azoospermic or carrying some genetic disorders, frozen donor sperm specimens are obtained from certified labs and thawed before the IUI procedure.
What is the IUI procedure?
Stimulate egg growth: Oral or injectable medications can be given for the development of one or two eggs. IUI can also be planned in the natural ovulatory cycle.
Follicular monitoring: Dominant follicle is monitored by doing follicular scans on frequent intervals.
Ovulation induction: Once the follicle is ready, injection (trigger) for the rupture of the follicle is given. IUI is posted 36 hours after the trigger.
Semen collection and washing: Once rupture is confirmed, the husband semen sample is collected and washed.
Insemination procedure: The sperm sample is injected into the uterus through a thin, long, flexible catheter. The sample is inseminated in the uterus via IUI catheter.
Is the process painful?
No, IUI is a quick and painless procedure and does not require anaesthesia unless the patient is very uncooperative or suffering from vaginismus or if a tight cervix is expected.
When is IUI not effective?
If the tubes are blocked or removed
Severe fallopian tube disease
In severe male infertility
Moderate and severe endometriosis
Risks involved with IUI
Fertility medications increase the likelihood of development of more than one egg. This can lead to multiple pregnancies.
Sometimes ovaries over-respond to the fertility medication and may lead to hyper-stimulation.
There is a small risk of infection following the IUI procedure. But since sterile instruments are used, infection is very rare.
Sometimes the process of placing the catheter in the uterus causes a small amount of vaginal bleeding for one or two days.
The success rate of IUI depends on the underlying cause of infertility. It works best in patients with unexplained infertility, women with a cervix that limits the passage of sperms and in the men who are unable to ejaculate effectively. Success rate of IUI decreases as the age advances. It varies from 12 to 15% per cycle. However, cumulative success rate after 3-6 cycles increases drastically.
Though the IUI is a widely chosen option for fertility treatment, it has its own limitations. So never hesitate to discuss all the fertility treatment options with your doctor.