IUI Treatment | Female First Hospital
What is intrauterine insemination (IUI) and how does it work?
Intrauterine insemination (IUI) is a laboratory procedure where fast moving sperms are separated from more sluggish or non-moving sperms. The fast moving sperms are then placed into the woman’s womb at the time of ovulation (when egg is released) .
What are The Indication of IUI?
- Unexplained Infertility
- Ovulation Problems
- Male partner experiences impotence or premature ejaculation
- What are the pre-requisites for IUI?
- At least one patent fallopian tube assessed by laparoscopy / HSG / Hysterosonogram.
- Significant problem with the sperms (numbers or quality or shapes).
- Normal uterine cavity evaluated by hysteroscopy / saline sonography / HSG
What are IUI Options?
- IUI with or without fertility drugs / injections (clomiphene / gonadotrophins) – as IUI can be given with or without fertility drugs to boost egg production.
How Does IUI Work?
1. For Women:
- Women using fertility drugs to stimulate ovulation, developments of eggs are monitored by vaginal ultrasound scans. As soon as an egg is mature, trigger (hormone) injection given to release the egg.
- The sperms are inserted 36 to 40 hours later, by the doctor through the vaginal speculum (a special instrument that keeps your vaginal walls apart).
- A small catheter (a soft, flexible tube) is then threaded into the womb via your cervix. The best quality sperm are selected and inserted through the catheter.
- The whole process takes just a few minutes and is usually a painless procedure but some women may experience a temporary, menstrual-like cramp.
2. For Men:
- Step 1: Men will be asked to produce a sperm sample on the day the treatment takes place by masturbation.
- Step 2: The sperms are washed to remove the fluid surrounding them and the rapidly moving sperm separated out.
- Step 3: The rapidly moving sperm are placed in a small catheter (tube) to be inserted into the womb.
What are the Chances of Success From Intrauterine Insemination(IUI)?
- It is difficult to assess success rates for intrauterine insemination (IUI) because success depends upon the cause of infertility and whether fertility drugs are used to stimulate egg production.
- It is around 20-25% for women aged under 35.
What are The Risks of IUI?
- Intrauterine insemination (IUI) itself is normally quite straightforward and safe.
- The risks are associated with the fertility drugs that are used with this treatment which are allergic reactions etc.
- Multiple pregnancies and Hyper stimulation in stimulated cycles.
- The use of ultrasound scanning before ovulation means that if there are more than two mature egg follicles present, the cycle can be abandoned.
In the process of IUI, the fertilisation of the egg and sperm occurs naturally, although the sperm is given a kind of “push” into the uterus. For this reason, both partners must meet certain criteria in order to have the best chances at success with IUI.
Role of USG in IUI:
Follicular monitoring, endometrial thickness and endometrial vascularity etc are continuously monitored by USG for successful IUI procedure
Sperm Washing Technique
What is Sperm Washing?
Sperm washing is a procedure used to prepare sperm for use in IUI. It allows your partner’s sperm a better chance for survival and fertilization. Sperm washing separates sperm cells from a man’s semen, helping to get rid of dead or slow-moving sperm as well as additional chemicals that may impair fertilization.
Why Sperm washing is Necessary?
Sperm must be washed in order to be used with IUI. Raw semen cannot be inserted directly into a woman’s uterus. This is because semen contains chemicals called prostaglandins. Prostaglandins cause muscular contractions and are responsible for cramps during menstruation and pregnancy. This leaves behind sperm that can swim faster and that are more likely to fertilize your egg.
Who Can Benefit From Sperm Washing?
Anyone who pursues IUI will receive the sperm washing procedure. However, the procedure can also benefit others, especially those with
- Unexplained Infertility
- Male-Factor Infertility
- Women with Endometriosis
- Men with Anti-Sperm Antibodies
- Sperm Washing Procedures
There are three commonly-used sperm washing techniques.
A. Simple Sperm Wash
Semen is diluted in a test tube with a special solution of antibiotics and protein supplements. It is then placed in a centrifuge, a machine that spins around at extremely high speeds. As the sperm mixture is spun, sperm cells fall to the bottom of the test tube, producing a mass of dense, highly active sperm. These sperm can then be removed from the test tube and used in IUI. A simple sperm wash takes about 20 to 40 minutes.
B. Density Gradient Sperm Wash
The density gradient sperm wash is one of the most popular sperm washing methods. This is because it also works to separate dead sperm cells, white blood cells, and other waste products from the sperm.
A test tube is filled with multiple layers of liquids of different densities. Semen is then placed on the top layer of liquid and the test tube is spun in a centrifuge. After it is spun, active, healthy sperm will make their way to the very bottom layer of liquid in the test tube, while debris and dead sperm will get caught in the top two layers. These layers can be siphoned off in order to remove the active sperm from the test tube. This sperm is then used in the IUI procedure. Density gradient sperm washes take approximately 60 minutes.
C. Swim Up Technique
The swim up technique is rapidly becoming more and more popular throughout American fertility clinics. This technique revolves around the fact that sperm need to swim forwards and up in order to reach the uterus. Only the most powerful sperm will be able to do this. In order to retrieve this powerful sperm, semen is placed in a culture dish with a layer of media culture. Sperm are attracted to this culture, and will swim up to it. As the sperm swim up to the culture, they are collected. This technique takes about two hours in order to harvest enough sperm for use in IUI.
How is insemination performed? What is the process for artificial insemination in humans?
- The woman usually is given medications to stimulate development of multiple eggs and the insemination is timed to coincide with ovulation – release of the eggs.
- A semen specimen is either produced at home or in the office by masturbation after 2-5 days of abstinence from ejaculation.
- The semen is “washed” in the laboratory (called sperm processing or sperm washing). The sperm is separated from the other components of the semen and concentrated in a small volume. Various media and techniques can be used for the washing and separation. Sperm processing takes about 30-60 minutes.
- A speculum is placed in the vagina and the cervical area is gently cleaned.
- The washed specimen of highly motile sperm is placed either in the cervix (intracervical insemination, ICI) or higher in the uterine cavity (intrauterine insemination, IUI) using a sterile, flexible catheter.
The intrauterine insemination procedure, if done properly, should seem similar to a pap smear for the woman. There should be little or no discomfort.
Most clinics offer for the woman to remain lying down for a few minutes after the procedure, although it has not been shown to improve success rates. The sperm has been put above the vagina and cervix – it will not leak out when you stand up.
Success Rate of IUI vary considerably and depend on
- Age Of The Woman.
- Type Of Ovarian Stimulation Used (If Any).
- Duration Of Infertility.
- Cause Of Infertility.
- Number And Quality Of Motile Sperm.
- Other Factors
Success rates for IUI in women over 35 drop off, and for women over 40 they are much lower. For this reason, we are more aggressive in “older” women.