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Intrauterine Insemination
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Infertility is defined as the inability of a couple to achieve conception or to bring a pregnancy to term after a year of regular unprotected intercourse. Infertility may be caused due to male factor or female factor abnormality or it may be unexplained. According to the World Health Organization (WHO), approximately 8-10% of couples who experience some form of infertility may require assistance for conception.
Evaluation of the couple helps to diagnose the cause of infertility and also serves to emphasize the spectrum of problem. Not all couples are infertile; about 15% are subfertile (who can conceive, but have fewer children than they want), whereas only 10% are infertile (who cannot conceive without assistance). Based on the diagnosis, various treatments can be opted for. Some treatment options include medications, intrauterine insemination (IUI), assisted reproductive techniques (ART), and third party donations.
Intrauterine Insemination (IUI) has been used for many years as a treatment method for infertile couples. IUI is performed during the ovulatory phase of the menstrual cycle, wherein the sperm specimen taken from the male partner is deposited directly into the uterus using a catheter that is passed through the cervical canal. |
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Who can opt for IUI? |
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 IUI is useful in women with cervical mucus problems like scanty mucus, presence of antisperm antibodies in the cervical |
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mucus,which are hostile to sperm. In the IUI procedure, sperm enters the uterine cavity directly, bypassing the cervical barrier. |
| The man may have antisperm antibodies in his own sperm. Such couples benefit immensely from IUI, because unaffected |
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sperms can be separated in the laboratory and good sperms can be used for IUI. |
| IUI can bring about positive results in couples with sexual dysfunction problems like impotence (inability to get and |
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maintain erection), vaginismus (it is a condition where involuntary spasm of the vaginal muscles occurs and penetration is not possible), or anatomic problems associated with the penis like hypospadiasis, where sperm cannot be ejaculated properly into the vagina. |
| Men who suffer from retrograde ejaculation (semen goes backward into the bladder instead of coming out of the penis) can |
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opt for IUI. In such cases, sperms are retrieved from the urine sample by a special laboratory process. |
| In women with ovulatory disorders, but having normal patent tubes, IUI can be combined with ovulation induction/ |
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superovulation to improve the chances of pregnancy. |
| IUI is a better option for couples with unexplained infertility. |
| IUI can be opted for as an alternative treatment for couples who cannot afford expensive treatments like ART. |
| IUI can be planned for women with absentee husbands (when the male partner is not available around the ovulatory |
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period),availing the option of prior freezing of the semen sample. |
| Though controversial, IUI can be useful in treating male factor infertility/subfertility to a certain extent. |
| IUI with donor sperm (Donor Insemination, DI) can be opted for in couples with severe male factor infertility, if they do not |
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opt for ART. Men with abnormal spermatogenesis or those having a genetic condition which can be transmitted to the offspring can also opt for DI. |
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| How successful is IUI? |
The insemination procedures can improve the chances of becoming pregnant, especially when combined with superovulation. The success of IUI depends on the period and cause of infertility, female partner age, associated factors of infertility, and the response to previous treatments taken.
The overall success rate with Clomiphene Citrate/IUI is about 8-10%, whereas in superovulation/IUI cycles, it is approximately 15-20%.
When IUI is done for mild male factor infertility/subfertility, the chances of pregnancy rates are double (6.5%) to that of a well-timed intercourse (3%).
Couples are advised to plan for 4-6 cycles of IUI as it increases the cumulative pregnancy rates (48.5%), which are higher than the rate achieved at the end of three cycles (9.3%). |
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How is IUI performed? |
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Ovulation induction/superovulation is planned to get two or three good quality eggs, follicular monitoring is done by transvaginal ultrasound examination, and when a mature follicle is obtained, injection hCG (human chorionic gonadotropin) is given to trigger ovulation. Ovulation occurs approximately 36-48 hours after the injection hCG. Accordingly, IUI is planned at 24 hour and 48 hour stages after the hCG injection to improve the fertilization chances.
The woman is asked to lie down in a dorsal position and draped. A sterile speculum is gently inserted into the vagina to clearly visualize the cervix. The cervix is held with an Allis forceps. A flexible IUI catheter, loaded with washed prepared semen sample, is gently passed through the cervical canal, and introduced into the uterine cavity. The sperms are then slowly injected into the uterus directly. |
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How safe is IUI? |
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IUI is a safe, less expensive, and more convenient procedure. It is a simple procedure, done on an outpatient basis, which takes only few minutes and does not require hospitalization.
The procedure is fairly painless. A few women may complain of cramping pain after the procedure; this is mostly attributed to ovulation related pain rather than from the IUI. Most women do not need any medication for the pain. Women who complain of cramping are advised to avoid strenuous activities for the rest of the day, and medication is advised only if pain persists.
Some women may have spotting or slight bleeding following the procedure. This is usually experienced by women with whom doctors have a technical difficulty in reaching the cervix. Sometimes, spotting may occur with ovulation.
There is a risk of hyperstimulation, which is associated with superovulation (excess generation of eggs). Proper monitoring of the ovulation induction reduces the risk of hyperstimulation.
Multiple pregnancies can occur in women treated with superovulation. So, an early ultrasound examination (between 42 - 49 days from the missed period) is advised once the pregnancy test is positive. |
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Common FAQs |
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1. How should a semen sample be collected?
The semen sample is to be collected in a sterile container (provided by the laboratory) by masturbation and should be delivered to the laboratory within half an hour of ejaculation, if collected at home. An abstinence period of 2 days is required, but it should not exceed 3 days.
2. Can the sperm fall out after the procedure?
Once the sperm is injected into the uterus, it does not fall out. However, increased wetness may be experienced due to the loosening of the cervical mucus (which occurs as the catheter passes through the cervix), and the mucus may flow out.
3. Can the couple have intercourse after IUI?
Yes, the couple can have intercourse anytime after an IUI.
4. Does a woman need to take rest after the procedure?
Women can work normally after the procedure. A woman is advised to take rest for the day if she experiences any cramping pain after the procedure. |
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Intrauterine Insemination |
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