IUI
What is IUI?
IUI or intrauterine insemination is a popular technique in which a fresh semen sample of the male partner processed in the laboratory is introduced directly into the uterine cavity. During natural intercourse, semen is ejaculated in the vagina and only 1-2% of sperms reach the uterine cavity for conception.
In IUI, semen sample is processed in the IUI laboratory to separate the sperms from the liquid pool of semen, which contains bacteria, pus cells and other debris. This separated sperm concentrate is then incubated with nutrient media to gain maximum sperm motility. Finally, this concentrated volume of prepared semen (0.4-0.5 ml) is instilled directly into the uterine cavity so that higher concentration of motile sperms are available at the site of fertilization thus improving the chance of conception. IUI can be done in a natural cycle also but best results are achieved when insemination is coupled with ovulation induction by fertility drugs.
Which couple benefits from IUI?
IUI is done to enhance fertility in couples where no definite factor appears to be responsible for couple’s infertility. Investigations of women should confirm that she is ovulating either naturally or with ovulatory drugs, has one or both fallopian tubes open and healthy and has a normal uterine cavity. IUI can also benefit couples with marginally low sperm count and motility (i.e. counts upto 10 million/ml).
Why is Donor Insemination?
Under normal circumstances, IUI uses sperms from the husband. However, in cases of severe male factor infertility where sperm count is zero or has severely abnormal sperms with regard to shape or motility, insemination can be done with screened sperm samples from anonymous donors with consent from the couple. These samples are available at authorized registered semen banks.
Steps of IUI treatment
1. Couple is evaluated by history and thorough investigations to see if they are fit for this procedure.
2. Ovulation-inducing drugs are usually started on Day 2 or Day 3 of menstrual cycle. Commonly used oral medicines are Clomiphene or Letrozole which are given for 5 days. Injections (Gonadotropins) can also be used for ovarian stimulation starting from day 2 or day 3 of the cycle. The injectable gonadotropins produce greater number and better quality of eggs which further increase the chance of pregnancy. Since injections are costly and have to be taken daily, they are usually reserved for cases where pregnancy fails to occur on oral drugs.
3. Monitoring of cycle is done by ultrasound (transvaginal) to see the growth of the follicles. Usually 3-4 ultrasounds are done in one treatment cycle. In patients on injections, blood tests (serum estradiol) may also be required.
4. When follicles are ready (atleast one follicle > 18 mm) one injection of hCG is given to cause the rupture of follicle and release the egg. After this injection, ovulation usually occurs between 36-48 hours.
5. After 34-36 hrs of hCG injection, couple is called for the procedure of IUI. Ultrasound of female partner is done to document ovulation. However, IUI can be done few hours before or after the ovulation. Fresh semen sample of male partner is collected before IUI and then it is washed, prepared and injected on the same.