Dr. Lavi Sindhu
Fertility & IVF Specialist
Intrauterine insemination (IUI) is an assisted conception technique that involves the
deposition of a processed semen sample in the upper uterine cavity to increase the chances of pregnancy. It is a cost-effective, noninvasive first-line therapy for selected patients, giving them a good chance to achieve pregnancy.
In this article, we will explore what IUI is, how it works, and the indications and success rate of this treatment option.
Intrauterine Insemination, also known as artificial insemination, is a fertility treatment that involves placing washed and concentrated sperm directly into the uterus. This procedure is timed to coincide with ovulation, which is when an egg is released from the ovaries and travels down the Fallopian tube.
A complete couple workup that includes patient history, physical examination, and clinical and laboratory investigations is mandatory to justify the choice in favor of IUI and guide alternative patient management. IUI may be performed with or without ovarian stimulation (medications to stimulate egg formation)
IUI is a relatively simple procedure that can be performed in an out-patient setting. Prior to the procedure, the male partner will provide a semen sample, which is then washed and concentrated to separate the healthy, motile sperm from the rest of the semen. The concentrated sperm is then placed into a sterile catheter, which is inserted through the cervix and into the uterus.
How Does Intrauterine Insemination (IUI) Work?
IUI works by increasing the number of healthy sperm that reach the egg, thus increasing the chances of fertilization and pregnancy. By placing the sperm directly into the uterus, IUI bypasses any potential obstacles that may prevent the sperm from reaching the egg, such as cervical mucus or scar tissue. It acts by overcoming natural barriers to sperm travel in the female reproductive tract and by increase concentration of motile sperms being placed directly into the uterus, close the site of egg release.
Who can get maximum benefit through IUI?
IUI is most effective for couples with certain types of infertility, such as unexplained factors, mild male factor, cervical factor, immunological factor or ejaculatory disorders and functional fallopian tubes.
It is generally not recommended for couples with severe male factor infertility, such as low sperm count or motility, as the chances of success may be lower and tubal factor infertility. Its role is limited in endometriosis and advanced maternal age >35 years.
Risks and Complications of Intrauterine Insemination (IUI)
Like any medical procedure, IUI comes with certain risks and potential complications Some of the risks associated with IUI include:
Multiple pregnancy: IUI increases the chances of multiple pregnancies if it’s done along with ovarian stimulation. This can increase the risk of complications during pregnancy and delivery.
Ovarian Hyperstimulation Syndrome (OHSS): In some cases, fertility medications used to stimulate ovulation can cause OHSS, a condition that causes the ovaries to become swollen, leaky, and painful. In rare cases, OHSS can be severe and require hospitalization.
Infection: The insertion of the catheter into the uterus can increase the risk of infection.
Couples need to discuss the risks and potential complications of IUI with their healthcare provider before undergoing treatment. Although in clinically experienced hands, the complications are rare.
Success Rates of Intrauterine Insemination (IUI)
The success rates of IUI can vary depending on several factors, including the age of the woman, the cause of infertility, and the number of IUI cycles undergone. On average, the clinical pregnancy rate of IUI is around 10-20% per cycle. However, success rates can be higher or lower depending on individual circumstances.
Factors that can affect the success rates of IUI include:
Important prognostic indicators of success with IUI include:
Age of patient, duration of infertility, stimulation protocol, infertility etiology, number of cycles, timing of insemination, number of preovulatory follicles on the day of hCG, and processed total motile sperm count (TMSC). The success rates of IUI tend to decline with age, particularly for women over the age of 35. IUI tends to be more effective for couples with certain types of infertility, such as unexplained infertility or mild male factor infertility.
It is important to keep in mind that IUI is not always successful, and some couples may need to consider other fertility treatments if IUI does not result in pregnancy.
Strict patient selection criteria and individualized stimulation protocols tailored according to the age and etiology of the patient with a strict cycle cancelation policy will help to reduce the associated complications, such as multiple pregnancies and OHSS, while maximizing the overall pregnancy outcome.
Three to four IUI cycles may be offered before considering alternate therapy. However, patients with advanced maternal age, severe male factor infertility, tubal pathology, or severe endometriosis will benefit from a direct referral to IVF/ICSI.
On the day of the procedure, the male partner will provide a fresh semen sample, which will be washed and concentrated in a lab. The woman will then lie on an exam table, and a sterile catheter will be inserted through the cervix and into the uterus.
The concentrated sperm will then be inserted through the catheter and into the uterus, and the catheter will be removed. The woman will then rest for a short period of time before being able to go home.
After the procedure, the woman may experience mild cramping or spotting, which should subside within a few hours. She may also be advised to avoid heavy exercise or strenuous activity for a short time. She will be advised to take certain medications to support the luteal phase and will be asked to report in case of a missed period.
Conclusions:
IUI is a simple, cost-effective, noninvasive first-line therapy for cervical factor, anovulatory infertility, moderate male factor, unexplained infertility, and immunological
infertility with clinical pregnancy rates ranging from 10 to 20%. Controlled ovarian hyperstimulation with close monitoring of folliculogenesis and ovulation to avoid adverse complications, such as ovarian hyperstimulation syndrome (OHSS) and multiple
pregnancies, may be used to obtain the adequate number of follicles. IUI is the preferred
conception-enhancing technique for women <35 years, functional tubes, short period of infertility, and moderate male infertility. Three to four IUI cycles may be performed before considering alternate therapy such as IVF.
If you are considering undergoing IUI, it is important to choose the best clinic with an experienced team and expertise in the procedure. At Vedanvit Fertility, we provide comprehensive and personalized fertility care to couples struggling with infertility. Our team of specialist doctors is highly trained in performing IUI and other fertility treatments. Individualised treatment protocols and techniques are used to give you the best possible success rate. Please reach out to us today to schedule a consultation and learn more about how we can help you achieve your dream of starting or growing your family.
For more information about our services or to book an appointment, contact us at 8287401364
Visit us at: C-8/566, First Floor, Sector-8, Rohini, Delhi.