Intra Uterine Insemination (IUI)

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Intrauterine insemination (IUI) involves a laboratory procedure to separate fast moving sperm from more sluggish or non-moving sperm.

 

The fast moving sperm are then placed into the woman’s uterus close to the time of ovulation when the egg is released from the ovary in the middle of the monthly cycle.

It is essential that your fallopian tubes are known to be open and healthy before the IUI process begins. A tubal patency test is usually carried out as part of your assessment by the fertility clinic to see if the tubes are open. 

 

The concentrated specimen of sperm is placed in the uterus. For this procedure, a speculum is inserted into the vagina and the cervix is visualized. A soft, thin catheter is then placed through the cervix and into the uterus. The washed sperm is then introduced into the uterus through this catheter. The procedure is done in the office and takes 1-2 minutes. It is not painful and does not require anesthesia.

 

Sperm Washing

The sperm sample is specially prepared in the laboratory. The procedure is commonly known as “sperm washing”. This involves placing the sperm sample in a test tube and then a centrifuge. This results in the sperm collecting in a “pellet” at the bottom of the test tube. The seminal fluid is removed and fluid (media) is placed above the sperm. The most active sperm will then swim up into the media. The final sample consists of the most active sperm in a small volume of media. A single IUI is usually performed when a fresh sperm sample is used. Two IUIs on consecutive days are usually performed if a frozen sample is used. 

 

Timing the Insemination

The timing of the insemination is not critical to the exact time of ovulation. Both the sperm and the egg remain viable in the female genital tract for many hours, so the insemination may be done within a window of several hours around the time of ovulation. Following the IUI, daily supplemental progesterone is given, usually in the form of a vaginal suppository.

 

IUI- Specific Indications

  1. Cervical factor – such as prior cervical treatment for dysplasia (cryotherapy, laser of the cervix, LEEP, etc.) or poor cervical mucus production. IUI bypasses the cervical mucous.

  2. Lack of conception after a woman has been on ovulation enhancing agents. This can be particularly important when taking Clomid since it can cause decreased cervical mucus.

  3. Mild to moderately abnormal semen parameters can be an indication for IUI.
    1. Oligospermia (low sperm concentration) – concentrations between 5-20 mill/ml.
    2. Asthenospermia (low sperm motility) – motility rates between 20-50%.
    3. Decreased progressive motility - between.
    4. Decreased morphology – Morphology between 6-14%.
    5. Decreased total motile sperm values.

  4. Unexplained infertility.

  5. Minimal – mild endometriosis.

  6. Use of frozen sperm.

  7. In case of psychological female problems, vaginism…

 

IUI preparation:

For women who are not ovulating regularly, the goal of treatment is to mature and ovulate at least a single egg – ovulation induction (OI). Clomiphene alone often works well to cause the ovaries to mature an egg. A typical protocol will involve taking clomiphene each day for cycle days 3-7 or cycle days 5-9. Ultrasounds and blood tests are then used to monitor the egg as it matures. Once the egg is ready, a subcutaneous injection is given of a hormone called hCG (the ‘trigger shot’), which triggers ovulation of that egg approximately 36 hours after the injection.

In women whose irregular ovulation is due to PCOS, a medication called metformin may be added to the treatment regimen. For those women who do not respond to clomiphene, FSH may be added to the protocol. In women who do not ovulate due to hypothalamic amenorrhea, injectable medications containing both FSH and LH are used to stimulate the ovaries to mature an egg. 

 

Superovulation and IUI

For women undergoing superovulation, the goal is to mature more than one egg at a time (usually 2 -4), sometimes referred to as controlled ovarian hyper-stimulation (COH). This is accomplished either with a combination of clomiphene and FSH or with FSH alone. 

A typical combination protocol may involve taking clomiphene each day for cycle days 3-7, followed by an injection of FSH cycle day 9. A typical FSH only protocol involves taking the FSH injections beginning on day 3 of the cycle and continuing daily until the eggs are mature. Again, the cycle is monitored with ultrasounds and blood tests to follow how many eggs are maturing and how quickly they are maturing.

Often with the combination protocol, additional FSH is used on subsequent days in the cycle if the eggs are not yet mature. When the eggs reach the required size, the trigger shot is given and the IUI is performed about 1 ½ days later. An Intrauterine Insemination (IUI) is routinely performed in the superovulation treatment cycle.

 

Success rates of IUI:

The success of IUI depends on several factors. If a couple has the IUI procedure performed each month, success rates may reach as high as 20% per cycle depending on variables such as female age, the reason for infertility, and whether fertility drugs were used, among other variables. While IUI is a less invasive and less expensive option, pregnancy rates from IUI are lower than those from IVF. If you think you may be interested in IUI, talk with your doctor to discuss your options.

 
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