IUI

Intrauterine Insemination

Couples that have been trying to conceive for a long time without success will likely eventually turn for help with conception. As assisted reproductive techniques have grown and expanded, infertile couples now have many different options to choose from, including fertility drugs like clomid and more intricate procedures such as IVF. Despite these advances, many couples still opt for one of the oldest and most reliable methods of assisted conception: intrauterine insemination.

What is Intrauterine Insemination?

Intrauterine insemination (IUI) is process whereby sperm are artificially placed in the uterus with the help of a catheter. This procedure helps to ensure that more sperm are available and able to access a woman’s egg, thereby aiding fertilisation and conception. IUI is the updated name for what was once known as artificial insemination. The reason for the name change is that artificial insemination can now occur in four different locations: the vagina (intravaginal insemination), the cervix (intracervical insemination), the uterus and the fallopian tubes (intratubal insemination). While artificial insemination is seen as an umbrella term for these four methods, intrauterine insemination is the more exact name that refers to the specific method of placing sperm in the uterus. Of the four methods, IUI is the most commonly used while intratubal insemination is rarely used as it involves an invasive procedure.

Who Can Use This Treatment?

IUI is usually suggested for those couples who have been trying to conceive for a year or more without success and have been found to have infertility issues. It is always recommended to perform a complete infertility examination before undergoing this process. In general, artificial insemination is used when:

• A woman’s cervical mucus is scant or hostile to sperm. Through IUI, sperm directly reaches the uterus, bypassing the cervix and the cervical mucus.
• The man has a low sperm count, though the sperm should be healthy.
• Male infertility due to antibodies to his own sperm. Sperm not damaged by the antibodies will be separated and used in the IUI process.
• Ejaculation issues due to vaginal muscle contractions or psychological problems.
• Retrograde ejaculation, a condition where the semen goes back into the bladder rather than being expelled from the body.
• Couples who cannot naturally have intercourse due to disability, injury or premature ejaculation.

In the process of iui, the fertilisation of the egg and sperm occurs naturally, although the sperm is given a kind of “push” into the uterus. For this reason, both partners must meet certain criteria in order to have the best chances at success with IUI.

Male Partner Requirements

Tests down on sperm prior to IUI must reveal normal functioning in terms of:

• Sperm count
• Mobility (movement of sperm)
• Sperm morphology (shape of sperm)

If sperm are naturally not healthy or they are misshaped, even the use of artificial insemination cannot induce fertilisation. Under some circumstances, the treatment may also be done using donor sperms. This is called AID (Artificial Insemination by Donor) or TDI (Therapeutic Donor Insemination). If using donor sperm, make sure it is tested for mobility, shape as well as quarantined for 180 days before use. Tests for infectious diseases and disorders, including HIV, must be performed on the semen sample before it can be used.

Female Partner Requirements

Because fertilisation and conception are still expected to take place as normal, the female partner will be tested to ensure that she has:

• A normal ovulation cycle
• Open fallopian tubes
• A normal uterine cavity

Sometimes, woman with ovulatory disorders or those who ovulate irregularly can undergo IUI with the help of fertility drugs. These drugs stimulate the brain to produce hormones that in turn induce the ovary follicles to mature into eggs. Once the eggs mature, IUI can be used to introduce the sperm inside the uterus. The timing of this particular procedure is important, as it is only when the egg and sperm are both present that fertilisation will occur. Woman suffering from endometriosis but who have a healthy pelvic structure may also benefit from IUI. Unfortunately, those with damaged fallopian tubes, poor egg quality, are over the age of 40, or who are menopausal are not candidates for IUI, as the chances of conceiving are too low.

The Procedure

Intrauterine insemination can be performed with or without the use of fertility drugs. However, using fertility drugs does increase the number of eggs your body matures and therefore increases the likelihood of conception. On the other hand, your risk of a multiple pregnancy is also increased. Discuss the pros and cons of using fertility drugs with your partner and your fertility specialist before deciding whether you would like to use fertility medications.

1. IUI begins with an ultrasound check-up of the female to determine the size of the follicles that can mature into eggs. She is then given oral fertility drugs, if she has decided to use these, to help stimulate a greater number of egg follicles to mature.
2. Next, with the help of ultrasound scanning and blood tests to check for oestrogen levels (estrogen is the hormone released by the female body to help the growth of the eggs), follicular growth is monitored. In women who have taken fertility medications, this also helps in individualising drug doses, keeping track of potential side effects and reducing the risk of multiple pregnancy.
3. In some cases, women undergoing IUI may receive an injection of human chorionic gonadotropin (hCG) hormone to stimulate egg growth and cause ovulation. Administering this hormone causes eggs to be released within 30 to 40 hours and provides a better assurance of an egg being present in the ovary when IUI takes place.
4. Timing is very crucial when dealing with IUI, as sperm has to be injected at the precise time when ovulation has occurred or is about to occur. Around the time of expected ovulation, a sample of fresh semen is collected from the male partner and processed in the lab by washing in a culture medium or using a density gradient column. This is done to obtain good quality sperm while minimizing the number of unhealthy, poor quality sperm. A prompt insemination after the processing is important to increase the success rate. Sometimes a sperm sample taken at an earlier date may also be frozen and later used for IUI.
5. Sperm is then inserted into the cervix and placed high inside the uterus by using a catheter. It is a painless procedure and does not take more than 20 to 30 minutes.
6. Once insemination is done, regular ultrasound monitoring and pregnancy tests are performed to find out whether the process was successful.

Risk Factors

While IUI is a relatively straight forward process, there are risks involved. This can include infection, brief cramping of uterus, or transmission of venereal disease from donor sperms. However, the strict quarantine applied nowadays by sperm banks has decreased the risk of viral transmissions dramatically. The use of fertility drugs brings with it the risk of a multiple pregnancy. In order to reduce this risk, your doctor may stop your cycle midway. The chance of a miscarriage occurring and having a low birth weight baby is high in the case of multiple pregnancies. Fertility medications may also cause a rare condition called ovarian hyperstimulation syndrome. Women affected by this will experience an enlarging of their ovaries and a collection of fluid in the abdomen. If this occurs, the IUI process may be stopped before insemination.

Success Rate

In a given cycle, the possibility of conception is 10% to 20% provided the sperm count is good and the female has a healthy fallopian tube. The woman’s age is also a deciding factor on the success rate, since advanced maternal age results in fewer follicles maturing into eggs. Doctors usually recommend trying two to three IUI cycles before opting for another fertility treatment, such as IVF.

Cost of treatment

Compared to other fertility treatments, IUI is relatively less expensive. Depending on the facilities provided by the clinic, the cost may be between 500 and 1000. This may or may not include the cost of drugs, hormone treatments, donor sperms and other added treatments.