Dr. Ulhas Pote

Fertility treatment intrauterine insemination (IUI)

Description
Faq's

Intrauterine insemination (IUI) is a form of assisted conception treatment. During IUI, your doctor will place selected, washed sperm into your womb (uterus) and near to your egg at your time of ovulation. This procedure is sometimes combined with fertility drugs to increase your chances of conceiving.

Could IUI help me get pregnant?

IUI is usually straightforward and painless, but it’s no longer recommended as a first-line fertility treatment. It may help you as a couple if:

You and your partner find it very difficult or are unable to have sex because of disability, injury, or a psychosexual problem.
You need extra help to conceive, for example, if your partner has a sexually transmitted viral infection and needs sperm washing to protect you and your potential child from the disease.
You’re in a same-sex relationship and want to use donated sperm to have a baby.

Some fertility problems, such as mild endometriosis, a mildly low sperm count or sperm quality, or unexplained infertility used to be treated with IUI. However, it is no longer recommended for these problems, as research found that success rates using IUI were no better than just carrying on trying to get pregnant naturally.

If you and your partner haven’t conceived after two years of trying, your doctor is likely to recommend IVF. If you have any cultural or religious objections to IVF then you may still be offered IUI.

For IUI to work, your fallopian tubes must be open and healthy. If your doctor suspects you have tubal damage or if you don’t become pregnant after having tried IUI, she may recommend that you have what’s called a tubal patency test. This will help to identify any problems or blockages in your tubes and can be done using one of the following methods:

laparoscopy, which is a form of keyhole surgery
hysterosalpingo-contrast sonography (HyCoSy), which uses vaginal ultrasound
hysterosalpingography (HSG), which is a form of X-ray

If you do have any blockages, you may be recommended IVF, or it may be possible to remove the blockage surgically.

How is IUI carried out?

In most cases, IUI is a straightforward treatment that does not involve the use of fertility drugs. If you do take fertility drugs it's called a stimulated cycle, because the drugs stimulate ovulation. If drugs are not used it's called an unstimulated cycle, or natural cycle.

Stimulating ovulation with IUI is not recommended by the NHS, because there is a much greater risk of a multiple pregnancy when taking fertility drugs. However, it may still be offered to you at a private fertility clinic.

Although having twins or more may sound appealing, multiple pregnancies increase your risk of miscarriage and other pregnancy complications. If fertility drugs are needed, IVF is usually recommended as an alternative because there is more control over the whole process and multiple pregnancy rates can be lower as a result.

In unstimulated cycles, IUI is timed to take place at the time when you’re naturally ovulating. Your doctor may ask you to use an ovulation predictor kit to work this out, or she may track your cycle using blood tests. IUI is usually done between day 12 and day 16 of a natural menstrual cycle, but the exact day will depend on your individual cycle.

If your fertility specialist has offered IUI during a stimulated cycle, you’ll probably be given fertility drugs in the form of tablets or injections. Clomifene citrate is usually the first-choice drug, although sometimes gonadotrophins are used. You’ll start taking the drug near the beginning of your menstrual cycle with the aim of stimulating your ovaries to develop up to two mature eggs for fertilisation.

An ultrasound scan will help to check that there aren’t too many eggs maturing. It also ensures insemination takes place at the best time. You may ovulate naturally, or be given an injection of a hormone called human chorionic gonadotrophin (hcg) to bring it on.

Sperm is then inserted into your womb within around 36 hours to 40 hours after the hcg injection. Your partner will be asked to provide a sperm sample on the day of the treatment. The sample will be washed to remove the fluid surrounding the sperm, then the best-quality and most mobile sperm will be separated out for use in the procedure.

Getting ready for the insemination is a bit like having a smear test, as you lie down on your back while your doctor inserts a speculum into your vagina to keep your vaginal walls apart. Using a catheter (soft flexible tube) through your cervix, your doctor will then put the sperm directly into your womb near a fallopian tube. This is the passage the egg travels along from your ovary to your womb.

Your doctor may ask you to lie still for about 10 minutes to 15 minutes after IUI . Then you’re free to carry on life as normal. You’ll be asked to take a pregnancy test in about two weeks.

What ia an IUI and how is it done?

An IUI — Intrauterine Insemination — is performed by threading a very thin flexible catheter through the cervix and injecting washed sperm directly into the uterus. The whole process doesn’t take very long. It usually requires the insertion of a speculum and then the catheter, a process that maybe takes no more than a couple of minutes (60-90 seconds to introduce the catheter, then sperm injection, and another 60 seconds or so to remove catheter — going slowly helps reduce discomfort).

Where ia the sperm collected? How long before the IUI?

The sample is collected through ejaculation into a sterile collection cup. If you are collecting at home, HFI requires that the semen be delivered to the office within an hour of ejaculation. Otherwise, we provide a collection room in the office for the male to use.

There is a delay between when the semen sample is dropped off and when it is inseminated to allow for washing of the sample. The amount of time depends on the washing technique used, which takes 30 minutes to two hours, as well as on the clinic’s scheduling. In most cases, we will perform the IUI as soon after washing is completed as possible.

When is the best timing to an IUI?

Ideally an IUI should be performed within 6 hours on either side of ovulation. When timing is based on an hCG injection, the IUI’s are usually done between 24 and 48 hours later. If two IUI’s are scheduled, they are usually spaced at least 24 hours apart.

What does an IUI like?

Most women consider IUI to be fairly painless due the thin flexible cathetar — along the same lines as having a pap smear. There can be some cramping afterward, but often what is felt is ovulation-related rather than from the IUI.

Do I have to lie down after an IUI?

Our doctors recommend patients lie down on the table for 15 – 30 minutes after the procedure.

Do I need to take it easy after an IUI?

We recommend patients take it easy for a while following IUI. Some people reduce their aerobic activity and heavy lifting during this time in hopes that it will increase the chance of implantation.

How long before an IUI should the male abstain from intercourse or ejaculating?

This depends on your individual situation, but it usually should not be more than 72 hours since his last ejaculation in order to ensure the best motility and morphology. If low sperm count is the reason for IUI, it is generally best to wait 48 hours between ejaculation and collecting sperm for the IUI.

How long after IUI should implantation occur?

Implantation generally takes place 6-12 days after ovulation — so 6-12 days after a properly timed IUI.

What kind of monitoring is usually done for an IUI cycle?

This depends mostly on how the female is being treated. A natural cycle is often timed with over-the-counter ovulation prediction kits. The use of Clomid can increase the monitoring, but usually only requires a handful of visits. Gonadotropins (injectable medications) increase the necessity of ultrasounds and bloodwork, requiring more frequent office visits.

What does "Sperm Washing" Mean?

It is sometimes also called sperm preparation or spinning. It is a laboratory technique for separating sperm cells from other supporting cells and fluid, and the separating motile sperm from non-motile sperm, for use in assisted reproduction (IUI, IVF).

The washing technique for near normal specimens is mixing the ejaculate after liquefaction with the appropriate washing medium followed by centrifugation (a centrifuge is a machine that separates materials with different densities by spinning them at high speed) The supernatant is discarded and the sediment (sperm rich fraction) is re-suspended in more washing medium. This process is repeated 2-3 times maximum. In the final wash, the sediment is re-suspended in 0.5 cc of medium, loaded into a syringe and deposited in the uterus.

Can IUI work after tubal ligation (have "tuble tied")?

No. A tubal ligation is effective birth control because it prevents the sperm and egg from meeting. The natural process that leads to pregnancy is having an egg released from a follicle in the ovary and then beginning the journey to the uterus through the fallopian tube. Sperm will travel from the vagina, through the cervix, through the uterus, into the tube where fertilization occurs. IUI bypasses the need for the sperm to travel through the cervix. However it doesn’t get the sperm to the other side of the tubal ligation, so fertilization won’t take place. The only way to get pregnant after tubal ligation is by having tubal reversal surgery or an assisted reproduction technology that includes egg retrieval, such as in vitro fertilization (IVF).

Can IUI be used for gender selection ?

Yes, sperm can be washed or spun to increase the odds of having a male or female offspring. For those patients who desire a specific gender, much higher results are generated with using PGD and IVF.