Intra-uterine insemination (IUI) also known as Artificial Insemination is a process in which the washed/processed semen is placed directly into the uterine cavity with the help of a thin sterile plastic tube (catheter) in and around the time of ovulation (release of egg from the ovary).
Fig. Diagrammatic representation of Intra Uterine Insemination (IUI)
It is one of the simplest techniques of assisted reproductive technique (A.R.T.). It forms the first basic and the least invasive treatment technique for infertility management.
The purpose of IUI is to introduce the best and the most motile sperms high up in the uterine cavity i.e. as close to the ovum as possible so that the distance that the sperms have to cover is the minimal and to overcome factors like cervical mucus opposition for its entry into the uterine cavity. Also as generally it is done with follicular monitoring, the egg is matured and released or about to be released. Hence we are sure that both the egg and sperm are timed properly for optimum fertilization and increased chances of pregnancy.
What are the indications of IUI or who will be benefited by doing this procedure?
IUI is performed for both male and female cause of infertility as well as in unexplained infertility.
The main reasons where it is used are as follows :
- Low sperm count and/ or less number of motile sperms
- Anatomic defects of the penis (abnormal structure of penis) leading to failure of deposition of sperm correctly
- Sexual or ejaculatory dysfunction (problems related to having sexual intercourse or release of sperms in the vagina)
- Retrograde ejaculation (occurs when semen, which would normally be ejaculated out via the urethra outside , is redirected back into the urinary bladder)
- Immunological (presence of antibodies to sperm)
- Increased viscosity (thick semen- does not liquefy easily to release the sperms )
- Cervical factors- Thick cervical mucus preventing the sperms to reach the uterine cavity. There are also sometimes antisperm antibodies (a protein that attacks and destroys the sperm) in cervix which are harmful to the sperms and prevent fertilization.
- Ovulatory dysfunction – No release or delayed or abnormal release of eggs (Oocytes) from the ovaries. Hence ovulation induction using drugs helps in increasing the conception rate.
- Minimal endometriosis – Grade 1-2 (presence and growth of the tissue lining the uterus in places other than the uterus e.g., in ovaries, fallopian tubes, intestine)
- Psychological and psychogenic sexual dysfunction ( Sexual intercourse is not possible )
I.U.I has also shown good results in cases of unexplained infertility (No apparent cause found for inability to conceive on routine recommended medical testing) as well.
In some cases where husband is away for many days due to job like military or navy, their semen sample can be frozen and used later. Once the follicle is of appropriate size and has ruptured, IUI can be performed at the correct time even in his absence. Thus even if the husband is not able to be present on the day of ovulation, husband’s previously frozen semen sample can be processed and insemination can be done.
Is there any condition for which IUI not suitable?
- Very low sperm count (less than 5 million) and poor motility
- Abnormal or blocked Fallopian tubes. .
- Abnormal or thin endometrial growth (Thin ET on USG).
- Advanced age of the wife, husband or both.
How long does one IUI cycle treatment take?
It takes the same time as a normal menstrual cycle i.e. on an average of four to five weeks from the beginning of menses cycle till the pregnancy test.
First sonography is done on day 2 or day 3 of menses to rule out cyst or any other abnormality. Later on she is put on ovulation induction drugs for 5 to 6 days and called for USG on day 7 or 8. Her USGs are repeated (folliculometry) and the follicles are monitored for growth. Once rupture occurs, IUI is done. This generally happens around 14 to 16 day of cycle. After IUI some medicines are given for support for another 14 days.
Is there any risk in performing IUI?
There is generally no risk in performing IUI for both the husband and the wife. It is one of the safest procedures. There may be a small chance of multiple pregnancies as sometimes more than one follicle may develop when ovulation inducing drugs are used.