Intrauterine Insemination (IUI)

Intrauterine insemination (IUI) is a popular method of assisted reproduction, in which washed and concentrated sperms are inseminated inside the uterus. The insemination is usually performed when the egg has been released by the ovary and is ready for fertilization. Unlike the older methods (in which the sperms were introduced in the vagina), this procedure has a much higher conception rate because it allows easy movement of sperms towards the egg through the fallopian tubes. Depending upon the patient factors, intrauterine insemination can be synchronized with normal menstrual cycles or with medications used for fertility treatments.

What Are Some Indications Of Intrauterine Insemination (IUI)?

Intrauterine insemination is ideally considered in the following situations:

1. Unexplained fertility

Intrauterine insemination is recommended to couples who are diagnosed with unexplained fertility. In order to increase the success rate of this procedure, healthcare professionals couple IUI with ovulation inducing drugs such as clomiphene citrate.

2. Infertility due to endometriosis

Endometriosis can lead to scarring of uterine tubes and may delay the transportation of sperms into the fallopian tubes. IUI significantly increases the chances of conception when used with ovulation inducing drugs.

3. Subfertility in men

Men who have poor quality sperms (i.e. high number of sperms with low motility or abnormal size or shape) can also get benefitted from intrauterine insemination. Individuals with below average concentration of sperms are also good candidates for IUI. The procedure also allows for the isolation of good quality sperms, providing higher chances of a normal pregnancy. Intrauterine insemination gives better results with high quality sperms.

4. Donor sperm

Intrauterine insemination is also ideal for women who are using donor sperms for conception.

5. Cervical factor infertility

Cervix is the narrow opening between vagina and uterus. At the time of ovulation, cervix releases mucus which allows easy travelling of sperms from vagina to the fallopian tubes. Movement of sperms can be obstructed if mucus is thick. Since IUI bypass this barrier by directly inseminating the sperms inside the uterus, the chances of egg fertilization and a healthy pregnancy are much higher.

6. Semen or Sperm Allergy:

Although it is rare, but some females are allergic to the proteins found in their partner’s semen. In semen allergy, when vagina comes in contact with semen at the time of ejaculation, the female partner experiences disturbing symptoms such as redness, flu like illness and localized swelling. These symptoms can be avoided by using condoms but this will also restrain pregnancy. IUI is an ideal procedure for such women because before insemination of sperms, semen proteins are washed off; thereby improving the chances of conception.

What Are Some Risks Associated With IUI?

• The risk of infections is generally low, but according to latest statistic, approximately 1% females develop serious infections.
• Vaginal bleeding may occur due to insertion of catheter in the uterus.
• IUI when combined with ovulation inducing medications may result in multiple pregnancies. Multiple pregnancies may induce early labor and low birth weight.

How Do You Prepare For IUI?

Initially the sperm specimen is washed to get rid of non-sperm elements which may impede the fertilization process or may elicit an allergic reaction in the woman. Washing of sperms also helps in the isolation of high quality sperms. Since insemination is conducted at the time of ovulation, careful monitoring of menstrual cycle is also required. This can be done via at-home urine ovulation predictor kit or a simple blood test. Transvaginal ultrasound is another method in which doctor examines the ovaries and growth of eggs. Human chorionic gonadotropin (HCG) injections may be given when monitoring is performed via transvaginal ultrasound. These injections allow ovulation of one or more eggs at the right time. IUI is usually performed after one or two days of ovulation detection.

Results

After the procedure you should wait for two weeks before taking pregnancy test at home because too early testing may result in false positive or false negative test results. Your doctor may call you after two weeks for more comprehensive blood tests. Blood tests are more sensitive at detecting pregnancy. You can also try IUI method again if you don’t get pregnant on the first couple of attempts. Chances of getting pregnant increases when same therapy is repeated for three to six months.

References

1. Kim, Y. J., Park, C. W., & Ku, S. Y. (2014, July). Indications of intrauterine insemination for male and non-male factor infertility. In Seminars in reproductive medicine (Vol. 32, No. 4, pp. 306-312).

2. Kop, P. A. L., van Wely, M., Mol, B. W., de Melker, A. A., Janssens, P. M. W., Arends, B., ... & Roovers, J. P. W. R. (2015). Intrauterine insemination or intracervical insemination with cryopreserved donor sperm in the natural cycle: a cohort study. Human Reproduction, dev004.

3. Peeraer, K., Debrock, S., De Loecker, P., Tomassetti, C., Laenen, A., Welkenhuysen, M., ... & De Neubourg, D. (2015). Low-dose human menopausal gonadotrophin versus clomiphene citrate in subfertile couples treated with intrauterine insemination: a randomized controlled trial. Human Reproduction, 30(5), 1079-1088.