Intrauterine Insemination (IUI)

Hi!

I am Dr. Jayanti Kamat. I am an IVF consultant, obstetrician and gynecologist. So today will be talking about IUI or intrauterine insemination. IUI or intrauterine insemination is the simplest procedure in artificial assisted reproduction technology. So what we do in this procedure is we deposit sperms, we concentrate sperms in the small amount of fluid and deposit it inside the uterus. The main purpose of doing an IUI is to shorten the distance between the male gamete that is the sperm and the female gamete which is the ovum. Now this IUI has certain prerequisites. Anybody it is not suitable for anybody and everybody.

So the first prerequisite is the in the husband he should have a moderately low sperm count, very low sperm counts are not suitable for IUI. Secondly there should not be any infection in the semen so if any infection is suspected in the semen a culture sensitivity test should be done. Similarly, in the female partner at least one tube should be open. Ideally both tubes should be open but at least if one tube is open IUI is suitable for that particular woman. Secondly even she should not have any vaginal infections before doing this procedure, vaginal infection or pelvic infection or pelvic inflammatory disease. Now, IUI is indicated for which patients? As I said when the male partner if has a moderately low sperm count, if he has retrograde ejaculation or if donor insemination has to be used then IUI is the ideal procedure. In the female, suppose she has anovulatory cycles and if she has mild endometriosis then IUI is suitable for her.

If both the husband and wife both their reports are normal and they have unexplained infertility even then know IUI will be the first line of treatment. Now what are the steps in IUI? The steps are: firstly a basic infertility workup should be done, then super ovulation normally only 1 egg is produced in a menstrual cycle. So by this method of super ovulation we are increasing the number of eggs so as to increase the chances of pregnancy. So how do we do this? Usually it is started from the second day of the cycle, the treatment so from the second day the woman is given certain tablets or certain injections. How do we know that she is ovulating or how many eggs are produced in the body? So we take, we monitor this by a procedure called as follicular monitoring. Now what is follicular monitoring? Follicular monitoring is we do a sonography and this sonography is ideally done by transvaginally that is called as transvaginal sonography or TVS.

So when we do this transvaginal sonography, we see how the follicles are growing, we see how many follicles are formed. At the same time we can also have a look at the lining of the uterus or the endometrium whether it is growing properly in accordance to the number of follicles. For as you all know ultimately when there is a pregnancy, the endometrium is very important because the embryo is going to get attached to the endometrium and implantation takes place inside the uterus. So that is about follicular monitoring. Once these eggs grow to a certain size maybe between 18-20 mm, then we give a injection that is human chorionic gonadotropin it is called as the trigger and once we give this injection the follicles rupture and release the egg.

After this giving the trigger, then we do this IUI procedure. So in this procedure the man has to give his semen in the lab, then we process the semen, we concentrate the sperm, the best sperms are used and concentrated in a very small amount of fluid and through a small plastic tube we put this sperms inside the uterus of the woman. Now this procedure does not require any anaesthesia. It is a daytime procedure. The woman can go home after 15 to 20 minutes after insemination. So we some doctors do this insemination twice. In our centre, we do this IUI twice on either side of the ovulation because we have studied that when we do the IUI twice there is a greater chance of success. Now what are the complications of this particular procedure? The complications are the patient may have a mild pain when the fluid is going through the tubes, when we inject the semen into the uterus; patient may experience a few cramps which will go away on its own.

Secondly if the semen is not processed properly or if the workup is not done properly, it can cause infection or if the follicle monitoring is not regulated properly then it can cause a problem called as hyper stimulation of the ovaries, when too many eggs are formed in the ovaries and this can cause retention of fluid in the body as well as collection of fluid in the abdominal cavity but this is very rare in an IUI procedure. Now where should an IUI be done? IUI should be done ideally in a IVF laboratory. Why? Because in the IVF lab we have that environment which is suitable for the survival of the sperms that is we there our temperature is regulated, the humidity is regulated so it's always better if it is done in an IVF lab because if it is done in the ordinary and if there is a time delay between the processing and the insemination it can cause the damage to the sperm.

Secondly if there are too many follicles during follicular monitoring we can easily convert this IUI cycle into an IVF cycle. So by this we are we can take advantage of the fact that the patient has produced many eggs. We can also do an IVF procedure and if there are too many eggs we can freeze them and use it for in the second cycle also. Third is the time factor. The IUI has to be done within 2-2.5 hours of semen collection. So this is possible if all the facilities are under one roof and also when all the facilities the treating doctor, the follicular monitoring, the processing of the semen and a good laboratory when they are in an integrated setup it causes it saves a lot of time and stress to the patient. The next question is, how many times can a couple do this IUI? IUI should be ideally done for 4-6 cycles and not more than that because it success rates are not increased by doing more number of IUI cycles besides the patient may be having a problem with fertilization for which IVF maybe the ideal choice of treatment for the patient. So if the couple does not conceive within 4-6 cycles of IUI, IVF will be a better choice.

For your any queries on IUI or IVF, you can contact me on lybrate.com.

Thank you.