What is Intra Uterine insemination (IUI)?
IUI is depositing of washed and concentrated motile sperm into uterine cavity through cervix using a fine plastic catheter. Intrauterine insemination (IUI) is widely accepted as the first line treatment for treating infertile couples.
Who are the couples that require IUI?
IUI is a first line treatment for following cases:
- Unexplained infertility
- Low sperm count
- Decreased sperm motility
- A hostile cervical mucus
- Erectile or ejaculatory dysfunction
- Sexual dysfunction
- Azoospermic males when IUI is done with donor
- IUI with cryopreserved Semen when the husband is working abroad
- Mild Endometriosis
- At times combined with ovulation induction in anovulation or PCOS patients.
When is it done?
It may be done in a natural cycle or combined with ovarian stimulation. IUI with ovarian stimulation improves success rates. Oral ovulatory agents are preferred as first line for ovarian stimulation. It is done usually on Day 12-16 of a cycle when the follicle is mature of 18 mm – 20 mm in size which can be traced either by doing urinary LH home kit or by follicular tracking study by ultrasound. It is done 24 hrs after the positive urinary LH surge or 36 hours – 40 hours after the hcg trigger injection.
How is it done?
Husband gives the semen sample in the laboratory which is washed and centrifuged with culture media which thus concentrates progressively motile sperms, into a small volume. This prepared sample is deposited in the uterine cavity thus close to the site of fertilization. The sperm bypasses the vaginal acidity and has to travel less thus saving its energy for fertilization.
Does it require anaesthesia?
It is a painless procedure carried out in an OPD and does not require anaesthesia
What is the success rate?
The intrauterine insemination success rate is upto 20% per cycle. It is recommended that at least 3-4 cycles of treatment are attempted before considering other options.
What are the limitations or side effects of IUI?
- IUI is absolutely a safe procedure and carries very minimal side effects.
- There might be cramping at the time of IUI because of the media used for preparation of semen sample.In majority of the patients, it subsides on its own after a while. Few cases might require pain killers like crocin or combiflam.
- There might be psychological impact more so on the male partner, which usually can be addressed by good counselling.
- The risk of infection is 0.01% – 0.2% of patients which is tackled well with antibiotics.
- The chances of multiple pregnancy and ovarian hyperstimulation are increased when ovarian stimulation is combined with IUI.
What is double IUI ??
Single IUI done 36 – 42 hours after hcg injection works well and a repeat IUI may have some role in patients with male infertility where repeating IUI 24 hours after the previous one increases the sperm density.
How many cycles of IUI are usually recommended for a couple?
70% – 80% of couples conceive with 4 cycles of IUI. IUI more than six cycles is not recommended.