Advantages of IUI

What is the Advantage of Having Semen Processing and Insemniation under One Roof?
May 26, 2015
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Advantages of IUI

  • High concentration of highly motile, best quality sperms are placed very close to the egg. This increases the chances of conception manifold.
  • Very simple procedure. No need of anaesthesia.
  • Patient can go home or to work soon after the procedure.
  • Extremely useful for couples with sexual dysfunction like dyspareunia, vaginismus, erectile dysfunction, non consummation of marriage, mild male factor infertility, grade I & II Endometriosis, unexplained infertility etc.
  • Usually husband is not required at all visits.

 

Disadvantages

  • The pregnancy rates are lower in case of IUI, approximately 10-15%. During folliculometry we document the release of the egg from the ovary. In the IUI procedure, we inseminate the active motile sperms into the uterus of the women, however we have no control over the fusion of the egg and the sperm. This explains the low pregnancy rates in case of IUI.
  • Apart from the time spent on visiting the doctor, there are no disadvantages of the procedure. IUI is one of the most basic procedures done to enhance fertility. We try and reduce the number of your visits to the clinic, so as to that the work burden on you doesn’t build up.
  • In most cases, 5-6 visits is all that is required. This includes the day we start ovulation induction, 3-4 follow up visits for follicular growth and a visit on the day of IUI.

 

IUI with normal semen parameters

  • It does make sense to try IUI if you haven’t had success with intercourse with a normal sperm count.
  • IUI increases the chance of success with injectable Gonadotrophins no matter what the sperm count is.
  • With intercourse, only few sperms make it through the cervical mucus and up into the uterus and fallopian tubes. With IUI, significantly more number of sperm will be available for fertilization.

 

Video of Semen Sample with Normal Parameters, Pre & Post Wash

Pre Wash

 

Post Wash:

 

IUI with abnormal semen parameters

  • Research has shown that an IUI done just prior to ovulation and repeated again after ovulation increases the conception rate specially in cases of sample with abnormal semen parameters.Therefore, we at Ankoor Fertility clinic, do “double insemination” in such specific cases.

Video of Semen sample with abnormal parameters

Precautions after IUI 

  • No precaution is the “Best Precaution”.
  • However, complete mental relaxation is what we want.
  • Apart from 10 – 15 minutes of lying down immediately after IUI, no additional bed rest is required.
  • There are no restrictions on travelling as also on mode of travel. You can safely travel by autos, 2 wheelers, local trains, metro etc…etc… It will not change your success rate.
  • You can safely go to work from the following day.
  • No restrictions on the food that you eat. One can definitely have papaya, mangoes, veg, non-veg, etc..without changing the success rate.

Medication after IUI

  • IUI is a very simple procedure. To enhance your conception rate, very few medicines need to be taken.
  • The medications given are generally various progesterone preparations used to support the pregnancy in the luteal phase (the phase of implantation of embryo and continuation of pregnancy after ovulation).
  • The progesterone preparations may be given in the form of oral drugs or vaginal preparations for insertion in the vagina or a combination of both oral and vaginal preparations.
  • These medicines are usually started a day after the IUI procedure.
  • The vaginal preparations are found to be superior to oral ones as they work locally (in the vicinity) without undergoing the systemic metabolism (absorption into the blood) and also giving higher pregnancy rates.
  • At Ankoor Fertility Clinic we evaluate the endometrium on Day2 or Day3 and the endometrial blood flow on Day 10 of the cycle. If the blood flow is found adequate and the endometrial lining is good, the likelihood of conception is higher. In cases of deficient endometrial blood flow, medications like Ecosprin, Sildenafil and Arginine are added. Studies have shown these drugs improve the implantation and conception rate. Such a holistic approach gives good results for our patients.

Pain during IUI

  • IUI procedure is usually painless per se. Most women feel a little discomfort similar to internal examination. The actual pain is generally not felt.
  • It’s more of fear of the procedure that results in pain/discomfort rather than IUI itself
  • In 1-2% of patients, there could be abdominal cramps or back pain after IUI, the severity of which is not more than the pain during periods.
  • Many women also experience ovulation pain which may contribute to the discomfort during IUI because IUI is done at the time of ovualtion.
  • Adequate information regarding the procedure and counseling will reduce the discomfort of the procedure.

 

Discharge/Semen coming out after IUI

  • Before IUI we clean the vagina with sterile gauze piece to remove the debris and the natural discharge.
  • Then we use a sterile medium solution to wash out the vagina before IUI and make it more receptive to the sperms. This fluid might trickle down to give you a sensation that sperms are coming out.
  • Also the motile sperms are injected directly into the uterine cavity which is higher up than the vagina and they will swim up as soon as they are injected into the uterus towards the fallopian tubes and not in the vagina. The semen sample is already into the uterine cavity once the catheter is removed. Thus it is normal to have some fluid discharge after the procedure but this does not contain the motile sperms.

 

Bleeding after IUI

  • IUI is a simple, atraumatic procedure taking a few minutes.
  • Generally there is no bleeding after IUI. However, bleeding can happen if the catheter does not enter the cervix (the lower part of uterus) and hence the need to hold the cervix with an instrument called tenaculum arises.
  • This is called as mild spotting and it stops in 24 hrs. In some patients ovulation itself could be associated with some spotting.

 

Intercourse after IUI

  • It is absolutely safe to have intercourse soon after IUI.
  • Infact, we recommend intercourse soon after IUI so as to make sure that the fertile period is completely taken advantage of.

 

Husband not available at time of IUI 

  • One can freeze the semen sample before an IUI procedure if they are physically away at the time of procedure.
  • Once semen sample is given to the lab; a complete semen analysis is performed which includes, volume, liquefaction and viscosity, sperm count, motility, forward progression and morphology.
  • This semen is then subjected to freeze and can be revived on IUI day (Freezing can sometimes reduce the motility of the sperms).

 

Outcome of IUI with frozen semen

  • Freezing process tends to kill off weaker sperms, and may thus lead to survival of the best sperms.
  • It does not change the success rate.
  • It has been documented in the literature that pregnancy has occurred using semen frozen for 21 years.

 

Implantation after IUI

  • In normal conditions, the sperm meets the ovum in the fallopian tube around ovulation, the fertilized embryo then travels the entire length of tube and implants in the uterus after around 5-6 days.
  • The same thing happens after IUI. Hence bed rest following IUI is not required.
  • This is the time required for fertilized egg to travel from your fallopian tubes to the uterus. This is also the time when lining of uterus will be ready to accept your fertilized egg.
  • At our centre, we do Color Doppler assessment of the Endometrial blood flow. If the blood flow is good, the receptivity of the endometrium for fertilized embryo is good. If the blood flow is inadequate, we at our centre, provide necessary treatment to improve the blood flow of the endometrium either in the same cycle or the next to increase the pregnancy rates.

 

VIDEO SHOWING GOOD ENDOMETRIAL BLOOD FLOW ON USG COLOUR DOPPLER

 

Good Endometrial blood flow at the time of ovulation

 

Post ovulatory good endometrial blood flow

What happens after IUI? 

  • Post IUI the medication for luteal support (2nd half of the cycle)is given for 14 days.
  • After stopping the medications, youneed to wait for 5 days.
  • If you don’t get your periods after that then you have to come for a checkup to “Ankoor Fertility center, Mumbai” to confirm pregnancy.
  • If within 5 days after stopping the medicines you get your periods, you have to come and see us on the second or third day of periods.

 

Detecting Pregnancy after IUI

  • If pregnancy occurs, there is release of hormone β HCG from the developing embryo. Serum levels of this hormone are measured to detect pregnancy. This hormone is also secreted in urine.
  • Pregnancy can be detected earliest around 14 days after IUI.
  • A simple urine pregnancy test done at home will tell you about your pregnancy.
  • If in doubt, blood test for hormone βHCG levels can confirm the same.

 

Method of delivery after IUI

  • Mode of delivery i.e. normal delivery or cesarean section is not decided by the way you achieve pregnancy. In the absence of any risk factors, you can safely have a normal delivery.

 

Success rate in IUI                    

The success rate of IUI depends on a multitude of factors like women’s age, ovarian reserve, previous obstetric history and semen parameters and most importantly on stimulation protocol used.

  • IUI done in natural cycles has a success rate of 8-10%.
  • Stimulation done with oral medications (Clomiphene Citrate) increases the success rate to 14 – 15%.
  • Use of injectable Gonadotrophins increases the rate of success to 18 – 20%.
  • Using highly potent recombinant Gonadotrophinsfurther increases the success rate.
  • Addition of GnRh antagonist increases the pregnancy rates further by 26-30%

 

Overall, at Ankoor Fertility centre, the success rate following 3 IUI has been 18-25%.

How to further enhance the success rate in IUI ?

At Ankoor fertility centre, we do a various unique things, so as to help you become pregnant faster and in a healthier way.

Trial cycle – Before commencing, we often do a trial cycle in which we observe the growth of your follicles, their rupture, the timing of rupture, whether spontaneous rupture occurs or not and most importantly evaluation of the endometrium.

Endometrial evaluation – Gametes are like seeds and the endometrium (lining of uterus) is like the soil. Just as for proper implantation of seeds, good soil is necessary, so is the endometrium for the embryo. We routinely evaluate the thickness and pattern of endometrium so as to prepare optimum endometrium and enhance the results.

This is done by serial Ultrasound at our clinic.

If found necessary, certain medications are given to increase the thickness and also Color Doppler for blood flow to endometrium is done. If the blood flow if found deficient, a medical treatment is initiated along with constant evaluation of the same to increase the live birth rates and decrease the abortion rates.

Video 2: Post ovulatory good endometrial blood flow

Evaluation of male partner – We do semen analysis in our Lab, so as to pick up any subtle abnormalities which might be present inspite of normal count and motility.

Certain specialized tests like Sperm Function Test, DNA fragmentation rate and Mitochondrial assay are done in specialized circumstances so as to enhance the result.

Sperm function test gives an idea of the capacity of sperm to fertilise an egg.

DNA fragmentation rate gives an idea of genetically normal sperms. High fragmentation rate is associated with higher rates of abortion.

 

What are the predictive factors influencing pregnancy rates after intrauterine insemination?

The predictive factors after IUI are as follows:

  • Female partner’s age (less than 35 years of age have better results),
  • Body mass index (BMI) (BMI <26 have better results),
  • Duration of infertility (Longer the duration of infertility, poorer are the results),
  • Type of infertility (primary versus secondary),
  • Follicle stimulating hormone (FSH) level and estradiol (E2) on third day of the cycle (If the Estradiol levels are 1000 to 1200 for 3 mature follicles, then the response is better),
  • Number of preovulatory follicles (More the number of follicles, better the response),
  • Endometrial thickness (If endometrial thickness is 9 to 12 mm around the time of IUI, then the response is better),
  • Total motile sperm (TMS) count (more than 5 million, better response) and ratio of progressive motile sperm.

 

Reasons for failure in IUI

  • The success of IUI depends on multiple factors like age of women, ovarian reserve, semen parameters, cause of infertility, duration of infertility etc.
  • Even in a natural cycle with couple having no abnormality, the success rate in a cycle is only 8-10%.
  • Failure can be due to poor quality egg, abnormal semen parameters or just due to probability of success.
  • Even if 2-3 IUIs have failed, you should not get disappointed as we have seen success after 6 cycles of IUI too.

 

Working women/couple and the number of visits to the clinic 

  • IUI is an outpatient procedure, so leaves from office are not required during the monitoring phase.
  • Moreover, at Ankoor fertility Clinic, most procedures are done in the evening after your office hours. 
  • Only on the day of procedure, half a day leave may be required, since the time from giving semen sample to processing the semen sample and doing the IUI procedure takes about an hour and a half to two hours.
  • If done during the morning hours, the busy schedule of the husband can be easily handled by allowing him to leave for his job after giving the semen sample and the initial semen count been checked. The wife could stay back till the procedure is over and resume duty after that.
  • Also, during the monitoring phase, husband is not required at all visits. However, if time permits he can accompany you.

 

Number of IUIs to be done in a cycle ?

  • Generally at “Ankoor Fertility Center, Mumbai”, we perform one IUI after confirming the rupture of follicle (release of egg). Usually the follicle ruptures after 36 hrs.of administration of HCG injection. Sometimes two IUIs are done in a cycle in selected group of patients like previously repeatedly failed IUI’s, male factor infertility, unexplained infertility and when time is a constraint (e.g. The husband is working abroad and has come to India for limited time period) etc.
  • In our experience by doing two IUI for male factor infertility like low sperm count or motility would give a higher pregnancy rates than one IUI in a cycle.
  • These IUIs are done generally at 24 hours and 48 hours after the hCG injection.

 

Failure in IUI

  • Usually for a perfectly healthy couple trying for pregnancy without any intervention, success rate in any given cycle is only 8 – 10%.
  • By doing IUI, success rate can be increased upto12%.
  • In case of failure to conceive in one cycle of IUI, the same treatment and procedure is usually carried ahead by most of the Gynaecologists. But we at Ankoor Fertility Clinic, go beyond this. Not only is a detailed counseling assured, but also a change in the ovulation induction protocol, a better endometrial evaluation and an approach to increase the male sperm count, improvement in the endometrial blood flow and a better support of the luteal phase, i.e. after ovulation to enhance the success of the treatment in the next cycle.
  • If oral medications were used for ovulation induction, we use Injectable Gonadotrophins can increase the success rate next cycle.

 

What is included in the IUI treatment cost?

  • Preparation of the Semen sample.
  • Insemination of the processed semen in the uterus of his wife

 

What is not included in the IUI treatment cost?

  • Initial consultation
  • Treatment planning
  • Monitoring Ultrasound scan
  • Cost of fertility drugs or injections
  • Fee for freezing sperm (if required)
  • Fee for donor sperm (if required)
  • Pregnancy test

 

Cost for IUI?

 

Cost of IUI depends on the medications used as well as the whether the consultation and folliculometry was also done with us. It also increases if a donor sample is used for IUI. The cost at Ankoor Fertility Clinic is around Rs. 5000/-, but it varies between Rs. 2000/- to 10,000/- depending on the above mentioned factors.

 

Number of IUIs before moving to IVF / next line of treatment ?

  • This depends on factors like age of the couple, cause for infertility, semen count of the male partner, number of years of infertility, any other associated factors involved etc.
  • In a young couple, at least 6 cycles of IUI with ovulation induction are advised whereas in an elderly couple (age > 35 yrs) 3 cycles of IUI are advised. Also in cases with mild to moderate Endometriosis, it is better to restrict to 3 cycles and then move to higher treatment. Individualization of the cases is done and same parameters cannot be used for all the patients.
  • A study conducted at Centre for Reproductive Medicine, Department of Obstetrics and Gynaecology, Academic Medical Centre, Room H4-213, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands stated that as many as 9 IUI cycles can be performed but at our centre “Ankoor Fertility Centre, Mumbai” we restrict to 6 cycles as we found that patient returning for further trial and pregnancy rates dropped after initial 6 cycles.Bottom of Form

 

What is Donor IUI?

  • At Ankoor fertility clinic, we also do Donor IUI. Donor semen is required in cases of severe male infertility with very poor sperm count or very poor motility. It is also done in cases of no sperms in the semen (azoospermia).
  • We screen the donor for infectious diseases like HIV, HbsAg, HCV (jaundice), VDRL (sexually transmitted diseases) and also the blood group. The donor is also matched physically as per the husband.

 

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