IUI ( INTRA UTERINE INSEMINATION )

For a woman to get pregnant, a man’s sperm must travel from the vagina through the cervix (narrow, lower part of the womb), into the uterus (womb), and up into one of the fallopian tubes. If sperm arrives in the tubes soon after the release of the egg from the ovary (ovulation), the sperm and egg can meet in the tube, most commonly, on the side that ovulation took place, and then fertilization may occur.

Because the cervix naturally limits the number of sperm that enter the uterus, only a few sperm actually make their way to the fallopian tubes. Intrauterine insemination (IUI) is a procedure that bypasses the cervix and places sperm into a woman’s uterus around the time of ovulation. Placing the sperm directly into the uterus makes the trip to the fallopian tubes much shorter. This way, there is a better chance that more sperm will make their way closer to the egg. This procedure is performed to improve a woman’s chance of getting pregnant.

When is IUI used for treating infertility?

IUI is useful when:
The woman has a cervical mucus problem – for example, it maybe scanty or maybe hostile to the sperm. With an intrauterine insemination (IUI) the sperm bypass her cervix and enter the uterine cavity directly.
The man has antibodies to his own sperm. The ” good” sperm which have not been affected by the antibodies are separated in the laboratory and used for IUI. If the man cannot ejaculate into his partner’s vagina. This is usually because of psychologic problems such as impotence (inability to get and maintain an erection) and vaginismus (an involuntary spasm of the vaginal muscles so that vaginal penetration is not possible); or anatomic problems of the penis, such as uncorrected hypospadias; or if he is paraplegic.

The man suffers from retrograde ejaculation in which the semen goes backward into the bladder instead of coming out of the penis. For unexplained infertility, since the technique of IUI increases the chances of the eggs and sperm meeting.
If the husband is away from the wife for long stretches of time (for example, husbands who work on ships or work abroad), his sperm can be frozen and stored in a sperm bank and used to inseminate his wife even in his absence.

How is IUI done?

Once collected, the semen sample is then “washed” in the laboratory, to concentrate the sperm and remove the seminal fluid (seminal fluid can cause severe cramping in the woman). This process can take up to two hours to complete.

IUI is performed near the time that the female partner is ovulating. The IUI procedure is relatively simple and only takes a few minutes. The woman lies on an examining table and the clinician inserts a speculum into her vagina to see her cervix. A catheter (narrow tube) is inserted through the cervix into the uterus and the washed semen sample is slowly injected. Usually this procedure is quite painless, but some women have mild cramps.

Timing
Timing the IUI is very important – it must be done during the “fertile period” when the egg is in the fallopian tube. Pinpointing the time of ovulation accurately using either vaginal ultrasound or ovulation test kits is crucial. A good clinic should provide this as a 7-day week service, since there is a 1 in 7 chance that ovulation will occur on a Sunday – eggs don’t take a holiday! It is important to superovulate the wife at the same time (with clomid or HMG injections) , so that she produces more than one egg. Superovulation increases her fertility potential as well, thus increasing the chances of conception by improving the chances of the eggs and sperm meeting.

The IUI is done either when ovulation is imminent or just after. The husband masturbates into a clean jar – preferably in the laboratory or clinic itself, and after at least three days of sexual abstinence to get optimal sperm counts. Some men may have considerable difficulty producing a semen sample at the appropriate time, because of the tremendous stress they are under, and the ” pressure to perform”. For these men, using a previously stored frozen sample can be helpful. Viagra (sildenafil citrate) can also be used to help them to get an erection, as can using a vibrator.

What is the success rate of IUI treatment?

Success Rates of IUI
The success rate of IUI depends upon several factors. First of all the cause of the infertility problem is important. For example, men with normal sperm counts who are unable to have intercourse have a much higher chance of success than patients who are undergoing IUI for poor sperm counts. In addition, female factors play an important role. If the female is more than 35, the chance of a successful pregnancy is significantly decreased. Generally, the chance of conceiving in one cycle is about 10-15%; and the cumulative conception rate is about 50% over 4 treatment cycles. (Remember, Nature’s efficiency for producing a baby in one month is about 15 to 25 %). However, if IUI is going to work for a couple, it usually does so within 4 treatment cycles. If a pregnancy has not resulted by this time, the chances of IUI working for you are very remote. You have reached the point of diminishing returns, and should stop persisting with IUI and explore the option of IVF

The best sperm are separated from the rest of the seminal fluid, by special laboratory processing techniques. This separation takes about 1 to 2 hours. The actual insemination procedure is simple and takes only a few minutes to perform. It is not painful, though it can be uncomfortable. The wife lies on an examining table, and a speculum is placed in the vagina. The doctor puts the sperm through a thin plastic tube (catheter) through the cervix into the uterus. There may be a bit of uterine cramping at this time; and some discomfort for about 12 to 24 hours. Some patients may experience a little vaginal discharge after the procedure, and they are worried that all the sperm are leaking out of the uterus. However, this discharge is just the cervical mucus – the sperms cannot “fall out” of the uterine cavity.

No special bed rest is required after the IUI. Some doctors may repeat the insemination after 24 hours. We usually encourage our patients to have intercourse on the night of the IUI, and for 2-3 days after this as well, to maximize the chances of the sperm and egg meeting