Intrauterine Insemination (IUI) Treatments

IUI is a process in which we put washed and prepared semen sample of partner in uterus of female partner, in order to get pregnancy.

INDICATIONS:

  • Oligospermia
  • Antisperm antibodies present (Aggulation of sperms)
  • Resistant cervical mucous
  • Unexplained infertility
  1. Oligospermia: – According to WHO criteria, if sperm count is less than 15 million/ml and motility of sperm is less than 20-30%, then by washing sperms, motility is improved and sperms are injected in uterus to reduce the distance between ovum and sperm. Sperms are put near to opening of tubes to achieve pregnancy.
  2. Antisperm antibodies: – sometimes if these are positive, sperms are agglutinated means they stick together to each other due to viscous sample; free motility of sperms is not there. So, and they are washed with media (washing medium with nutrients) and injected into uterus to assist conception.
  3. Resistant cervical mucus:-sometimes in female partner, thick cervical mucus is there on the entry of uterus, so when sperms try to enter in uterus, they get stick into this mucous plug and become dead. So, to bypass this path, processed sperms are put directly inside the uterus bypassing cervix.
  4. We understand by this term is that few months have passed trying for conception with all reports normal. Semen analysis report is normal and female partners fallopian tubes are patent, ovum forming and rupturing on time, but then also conception not taking place, then few cycles of IUI are advised.

 PRERQUISITE OF Intrauterine Insemination

It means certain criteria are to be fulfilled before deciding IUI for any couple.

  • Ovum should be of optimum size (19-20mm)
  • Ovum ruptures on Time
  • Fallopian tubes are checked and( hysterosalpingography)should be open.
  • Sperm count 5-15million/ml with 20-30% motility

IUI NOT INDICATED IN

  1. Blocked or deceased fallopian tubes
  2. Semen count very low(less than 5millions or very low motility)
  3. Low antimullerian Hormone (Egg quantity have reduced)
  4. Ovum not reaching to proper size and met rupturing in time
  5. History of Repeated cyst/ Endometrioma formation in ovaries.

IUI PROCEDURE

After doing semen analysis of male partner and checking of fallopian tubes of female partner, we decide for IUI in a couple. From the second day of menstrual cycle, we start low fertility drug (tablets) to mildly stimulate ovaries and start doing follicle monitoring starting from the 2nd/3rd day of menses. The follicle should grow 1-2 mm per day. Monitoring is done by ultrasound transvaginally calling them on second, fifth, ninth days etc. as the follicle is growing. If stagnancy in the growth of follicle, low dose gonadotrophin hormone in the form of injection is given. By all this, when follicle reaches the appropriate size of 19-20 mm with good blood flow (checked of Doppler USG), Inj. HCG (Human Chorionic Gonadotrophin) is given to rupture the follicle so that we can timed the IUI and put sperms closest to time of rupture. Time is calculated as follicle normally ruptures around 36 hours after Inj. HCG. So, HCG has two roles to play- one for rupture and other to time our IUI process.

For IUI, we normally call the patient at 30-34 hours of giving Inj. HCG, when couples comes for IUI after taking consent, we ask male partner to give his semen sample. After collection, it is kept in Andrology lab for 15-20 minutes to get diluted, then mixing with media, it is centrifuged. Method is decided by embryologist depending on condition of sample-whether do swim up or density gradient method. Normally it takes around 45 min- 1 hour for preparation. Meanwhile we check female partner for follicle rupture on USG. As sperm are ready to be inseminated, after preparation female partner with the help of IUI cannula. Sperms are inseminated in uterus slowly over 3 minutes, she is advised to rest for 15-20 minutes. No rest is advisable after that; she can carry out her normal routine life as before. After 14 days of rupture, we call her for pregnancy confirmation.

WHAT ARE THE RISKS OF IUI

It is simple, painless process with no risks involved and no extra precautions needed.

SUCCESS RATE OF IUI

The success rate of IUI depends upon various factors like the semen sample is prepared and how near to rupture time sperms are inserted in uterus and overall conditions of fallopian tubes and sperms.  The success rate of IUI is around 15-25% each cycle.

IUI COST

It depends on individual or infertility center but it varies from 8000 -25000 INR.including follicle monitoring, fertility drugs and main process.

How many cycles?

It is not right approach to do ‘n’ number of cycles, because with every cycle quantity of female ovum is reducing. So, doctor should decide keeping in view of future procedures, if needed.so, maximum cycles advisable are 3-4 IUI cycles. If not conceived, we should go to next approach of conceiving-that is IVF.

Why IUI at our centre

  • Our specialist makes sure that patient is right subject for IUI fulfilling all pre-requisites; cases are selected carefully, not just to do procedures.
  • Semen analysis and fallopian tubes are checked before IUI is must.
  • Semen preparations is done in well equipped andrology lab with high-quality media(normally used for IUI cases)
  • Pre rupture and post rupture IUI are done ,so that to get better results
  • Our success rate is 20-30% per cycle.
  • Our main aim is to give pregnancy and to give 100% to procedure selected for the patient.

 

CONCLUSION

  • IUI to be done when indicated.
  • All pre requisites must be fulfilled before the procedure.
  • Don’t do IUI, if not fulfilling criteria’s.
  • Procedure should be followed maintaining all precautions and good techniques.
  • Good quality media and well equipped andrology lab is must.
  • Consent from couple for IUI after explaining procedure transparently is must.
  • Female partner can continue all her work after IUI.No extra rest is needed.
  • Success rate is 20-25% average per cycle.
  • Not more than 3-4 cycles should be done.