Intrauterine Insemination
iui

Intrauterine insemination (IUI) is the placing of sperm into a woman's uterus when she is ovulating. This procedure is used for couples with unexplained infertility, minimal male factor infertility, and women with cervical mucus problems.


Injection of washed prepared sperms into the uterine cavity through a fine catheter during peri-ovulatory phase in a natural or stimulated cycle.




Types of IUI:


1) Artificial Insemination of Husband Sperm (AIH)

2) Artificial Insemination of Donor Sperm (AID)




Candidates for IUI:


If the simple treatment of tablets and natural timings does not work, the couple is advised to take the next step, which is normally IUI (Intrauterine insemination). This involves taking the tablets again for 5 days, followed by regular scans to check the growth of the egg. When the egg is ready as per the scan, an injection is given to release it at a fixed time. At this time, the husband gives a semen sample. This is then processed to select the best sperms to put in the right place (womb) at the right time (egg release time) by a fine catheter. This has a nominal success rate of 15 to 17%. This means that the chances of failure are very high and the treatment has to be done repeatedly sometimes.


If this is not working, the couple may lose their faith in the doctor and go to another clinic. Unfortunately, the tests may have become old and the doctors may wish to repeat the tests. Now this clinic may its own different arrangements. The couple is now dealing with new staff and doctors and that must be challenging. Sometimes, couples travel a long distance to undergo the treatment from a particular clinic and this can have a serious impact on their sufferings.


If three to four IUIs do not work, the couple is getting fedup and may take a break to relax a little. If they are not counseled properly at this stage, they may keep doing too many IUIs. In the process, they start taking excessive medications, which can harm them later and reduce the chances of success using the advanced treatment. This must be avoided at all costs. It is very important that the couple understands the full process and is doing the treatment with complete knowledge.


When they are ready to restart their treatment, they are now faced with some difficult choices. The first is to consider one or two more IUIs to keep the treatment simple and the second is to perform a laparoscopy and hysteroscopy and then some more IUIs. Laparoscopy and Hysteroscopy is an operation involving small cuts on the woman’s tummy. A fine telescope is introduced inside the tummy to check if the tubes are open and if there are any other undetected issues. If any problem, such as a tubal block, fibroid or endometriosis is found, it should be treated at the same sitting. In some centre’s, such facilities and skills may not exist for the operative part and that part is performed at a later date again. This leads to doubling of the effort and should be avoided preferably. In some women, this operation gets performed repeatedly and leads to increased pain sufferings and costs.



Step by step in IUI


1. Drug treatment, to stimulate several eggs to mature

  • - Usually gonadottropins to stimulate the growth of follicle and cause ovulation

2. Monitoring of treatment, to measure the growth of follicles, individualise drug doses, and prevent serious side effects

  • - By transvaginal ultrasound scanning
  •   two or three times during a treatment cycle
  • - Sometimes by measuring hormones in a blood sample

3. Sperm sample, provided on the morning of ovulation, is prepared and interested later that day


4. Preganacy testing, monitoring




What if IUI does not succeed?


In the process of trying tablets, IUIs and maybe laparoscopy and hysteroscopy, most of the times two more years have gone by. The couple may be about 5 years into the marriage. The age of the woman and the family pressures are increasing. They are fedup and tired of doing the IUIs and follicular sonographies. This may appear to be a simple form of the treatment, but it starts appearing to be meaningless. They are now getting mentally ready to move further into the advanced form of the treatment (IVF-test-tube baby).



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