Intrauterine Insemination (IUI)

What is it?

It is the method by which a quantity of collected semen from husband or donor is introduced into the female partner’s uterus by means other than sexual intercourse to enhance fertilization. In certain individuals this may increase the likelihood of conception. IUI may avoid cervical and vaginal factors preventing sperm entry or compensate for low sperm counts. Intrauterine insemination is sometimes called artificial insemination or therapeutic sperm insemination.

Who are the candidates?

  • Oligospermia,
  • Asthenospermia
  • Impotence,
  • Retrograde ejaculation
  • Antisperm antibody
  • Cervical hostility
  • Unexplained infertility
  • Failure of getting pregnancy after 6 ovulatory cycles.
  • Cryopreserved sperm

                    Husband abroad
Before chemotherapy
* For female partner at least one fallopian tube must be patent and healthy.
* For male partner sperm count must be at least 10 million/ml with 50% motility.

How is it done?

It has two parts

  • Preparation of female partner
  • Preparation of semen and insemination

Preparation of female partner:

Female partner is to be prepared by using ovulation inducing drugs. Once follicles get matured ovulation is triggered by giving hCG and IUI is performed between 36 to 40 hours of hCG injection. If it is done twice in a cycle it is done at 24 hours and 48 hours of hCG injection.
It also can be done in natural cycle after monitoring the follicular growth and LH surge.

Preparation of semen and insemination:

Male partner provide semen on the day of procedure by masturbation. Then it is processed in the laboratory. Semen has to be treated to remove chemicals in the liquid portion of the semen which may cause irritation of the uterus. Sperm samples are usually collected in the clinic to assure a prompt delivery to the lab. In the lab, the specimen will be allowed to liquefy. Different types of special liquids called sperm media are used to rinse the debris and chemicals from the semen. The concentrated mixture that remains is made mostly of sperm. Gradient washes are often done to improve the concentration and selection of motile sperm. The washed sperm is now safe and ready for insertion into the uterus.
The insemination is a relatively simple procedure and is done without anesthesia. A small plastic catheter (tube) is used to insert the specimen into the uterine cavity through the cervix. A small amount of leakage and/or spotting can be anticipated after the procedure. This does not reduce the effectiveness of the technique. Once the procedure is completed there is no limitation of activity even intercourse.

The procedure is done only once per cycle because the time of ovulation can be accurately predicted and the insemination can be timed to coincide with the release of the eggs. Sometimes it can be done at two occasions in one cycle. Once inside the uterus, the sperm will rapidly disperse throughout the reproductive tract. Surface tension and motion from the fallopian tubes help with this process.

How does it work?

  • It allows one to by pass the cervix to deposit sperm closer to the tubal ostia, thereby facilitating a large number of motile sperm to reach the fertilization site.
  • Procedure removes the dead and moribund sperm which generate free oxygen radicals which reduce the functional capacity of intact sperm.

How many cycles it can be done?

There is no hard and fast rule for number of cycles. But it is better to do
6 cycles for women < 35 years and
maximum 4 cycles for women 35 and above

Success rate:

Vary considerably and depends on the
*  Age of women
*  Type of ovarian stimulation
*  Cause of infertility
* Number and quality of motile sperm

By and large birth rates per cycle of IUI

    • 15% under the age of 30
    • 12% between 30-35
    • 7%-8% between 35-39
    • <2% over 40
    • Cumulative success rate rises up to 60% after 4-6 cycles