IUI – Intrauterine insemination
IUI Procedure overview :
Intrauterine insemination (IUI) involves deposition of a motile sperm fraction in the uterus nearing the time of ovulation (egg release).
The goal of this procedure is to place the spermatozoa close the egg, so as to increase the probability of the sperm reaching the fallopian tubes, fertilizing the egg and thus leading to a pregnancy.
The motile sperm fraction is deposited beyond the cervical opening using an extremely soft and flexible catheter. This procedure can be done only once a month at the time of ovulation, but in some center’s a technique of double IUI is also done, were two preparations are consequently inseminated near the time of egg release.
It remains debatable whether this is of any value in significantly improving clinical pregnancy rates. An IUI can be done for a couple only when the female partner has bilateral patent tubes (as verified with a hysterosalpingogram or a diagnostic laparoscopy).
IUI as a technique is extremely well established and probably the most cost effective fertility therapy for a couple suffering from involuntary childlessness.
In an IUI, the semen sample collected by masturbation is prepared utilizing standardized semen preparation protocols like swim up, density gradient separation or by a combination of methods to separate the best motile fraction from immotile and non progressively motile sperm. Just look at the image below!
The rationale behind separating only the motile sperm fraction is that, only the motile sperm can swim from the site of deposition and reach the egg.
As per the ESHRE (European society of human reproduction), global success rates for IUI ranges from 10% to 12% with autologous semen (husbands own semen sample).
For men who suffer from Azoospermia (no sperm in the ejaculate and centrifuged re-suspended sample), utilization of donor sperm yields slightly higher success rates of 14%.
IUI is a good option particularly when the female partners age is less than 35 years.
When to do an IUI?
An IUI procedure is usually recommended for the following category of patients facing fertility problems
A. Unexplained infertility
B. Semen parameter abnormalities like decreased sperm concentration or decreased sperm motility or a combination of multiple sperm parameter abnormalities
C. Cervical scarring or cervical mucus abnormalities
D. Sexual dysfunction
E, Non consummated marriage
F. Morbid Obesity preventing intercourse
Types of IUI
IUI can be done in a natural way or by a stimulated way were drugs like clomiphene citrate, gonadotrophin injections and/or a combination of these drugs is often utilized.
IUI – Natural Cycle:
In this technique the patient does take any medications and/or injections to stimulate egg growth and IUI is planned at a time of where the egg growth and release occurs naturally. The timing of ovulation and prospective egg release is monitored carefully using a combination of ultrasound and blood tests.
IUI – Stimulated Cycle:
Drugs for ovulation induction like clomiphene (most commonly used) or Gonadotrophin are given at the beginning of the menstrual cycle to stimulate the ovaries to develop several mature eggs. After administration of the drugs, serial ultrasound scans are done to locate and monitor the development of follicles and the maturation of eggs.
IUI Is planned within 36 hours post HCG injection (a drug which mimics the LH surge).
On the day of IUI, the semen sample collected by masturbation is washed and prepared in a way where numerous motile spermatozoa are separated from seminal plasma.
Different methods of separation exists and it is debatable as to which is the best method. Finally the most motile sperms are loaded in a fine, soft catheter and introduced into the uterus through the cervix under aseptic precautions. The whole process only takes few minutes and is relatively pain free. The patient can resume all normal activities at the earliest. A pregnancy test is then done 14 day post the IUI.
IUI with Donor sperm – When is it done?
Indications for IUI with donor sperm takes place when a couple is faced with the following health issues impairing their fertility
A. Azoospermia (no sperm in the ejaculate)
B. Severely subnormal sperm parameters
C. Recurrent failure of ICSI when using the couple’s own gametes
D. RH iso-immunisation
E. Hereditary diseases in the male partner which can be transmitted to the offspring
IUI and it’s risks :
An IUI procedure has a very minor risk of a multiple pregnancy especially when drugs like gonadotrophins are used to stimulate the ovaries into producing multiple follicles. Apart from this risk, in general IUI is very safe and effective fertility treatment for a variety of infertility issues. A very minor risk of infection is also present when an IUI is done.
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