IUI

Intrauterine Insemination

If you want to get your own child, but you haven't get for a long time, don't be sad, you can try this method IUI (Intrauterine Insemination), one of the oldest and most reliable methods of assisted conception.

What is Intrauterine Insemination?

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 only requires the insertion of a speculum and then the catheter, a process that maybe takes a couple of minutes.

IUI is the updated name for what was once known as artificial insemination. The reason for the name change is that artificial insemination can now occur in four different locations: the vagina (intravaginal insemination), the cervix (intracervical insemination), the uterus and the fallopian tubes (intratubal insemination). While artificial insemination is seen as an umbrella term for these four methods, intrauterine insemination is the more exact name that refers to the specific method of placing sperm in the uterus. Of the four methods, IUI is the most commonly used while intratubal insemination is rarely used as it involves an invasive procedure.

Who Can Use This Treatment?

IUI is usually suggested for those couples who have been trying to conceive for a year or more without success and have been found to have infertility issues. It is always recommended to perform a complete infertility examination before undergoing this process.

In general, artificial insemination is used when :

• A woman’s cervical mucus is scant or hostile to sperm. Through IUI, sperm directly reaches the uterus, bypassing the cervix and the cervical mucus
• The man has a low sperm count, though the sperm should be healthy
• Male infertility due to antibodies to his own sperm. Sperm not damaged by the antibodies will be separated and used in the IUI process
• Ejaculation issues due to vaginal muscle contractions or psychological problems
• Retrograde ejaculation, a condition where the semen goes back into the bladder rather than being expelled from the body
• Couples who cannot naturally have intercourse due to disability, injury or premature ejaculation

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.

Male Partner Requirements

Tests down on sperm prior to IUI must reveal normal functioning in terms of :

• Sperm count
• Mobility (movement of sperm)
• Sperm morphology (shape of sperm)

If sperm are naturally not healthy or they are misshaped, even the use of artificial insemination cannot induce fertilisation. Under some circumstances, the treatment may also be done using donor sperms. This is called AID (Artificial Insemination by Donor) or TDI (Therapeutic Donor Insemination). If using donor sperm, make sure it is tested for mobility, shape as well as quarantined for 180 days before use. Tests for infectious diseases and disorders, including HIV, must be performed on the semen sample before it can be used.

Female Partner Requirements

Because fertilisation and conception are still expected to take place as normal, the female partner will be tested to ensure that she has :

• A normal ovulation cycle
• Open fallopian tubes
• A normal uterine cavity

Sometimes, woman with ovulatory disorders or those who ovulate irregularly can undergo IUI with the help of fertility drugs. These drugs stimulate the brain to produce hormones that in turn induce the ovary follicles to mature into eggs. Once the eggs mature, IUI can be used to introduce the sperm inside the uterus. The timing of this particular procedure is important, as it is only when the egg and sperm are both present that fertilisation will occur.

Woman suffering from endometriosis but who have a healthy pelvic structure may also benefit from IUI.

Placing the Sperm

The IUI process is when a very thin flexible catheter is inserted through the cervix and washed sperm is injected into the uterus.

Most women consider IUI to be fairly painless, 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. The catheter usually doesn't feel like much since the cervix is already slightly open for ovulation, a poorly timed IUI might cause more discomfort at the cervix.You don't have to lay down every minute every second because the cervix doesn't remain open, but most doctors let patients lay down on the table for 15-30 minutes after the procedure. Once the sperm is injected into the uterus, it does not fall out. There can, however, be increased wetness after the procedure because of the catheter loosening mucus in the cervix and allowing it to flow out. Some doctors will insert a cup around the cervix to prevent leakage, but most do not. Since the vagina doesn't open unless something pushes it, it is OK to swim shortly after your IUI , but because of how much one has invested in getting pregnant, it probably makes sense to wait 48 hours after your IUIs to go swimming.

Then you will be given instructions on how long before an IUI should the male abstain from intercourse/ejaculating and store up sperm. This depends on your individual situation, but it usually should not be more than than 72 hours since his last ejaculation in order to ensure the best motility and morphology. In fact, most doctors suggest having intercourse, when that is an option, soon after the last IUI to help make sure ovulation is covered. Your doctor may suggest waiting 48 hours to resume relations if you had any bleeding during the IUI or if a tenaculum is used.

When Should it be Done?

Ideally an IUI should be performed within 6 hours either side of ovulation (for male factor infertility, some doctors believe after ovulation is better) with the sperm waiting for the egg. When timing is based on an hCG injection, the IUIs are usually done between 24 and 48 hours later. Typical timing would be to have a single IUI at about 36 hours post-hCG. If two IUIs are scheduled, they are usually spaced at least 12 hours apart between 24 and 48 hours after the hCG.

Risk Factors

The main risks are some discomfort such as cramping, minor injury to the cervix that leads to bleeding or spotting, or introduction of infection (including sexually transmitted disease from the sperm itself, it helps to be sure of the known donor's health, or use carefully monitored frozen specimens). However, the strict quarantine applied nowadays by sperm banks has decreased the risk of viral transmissions dramatically. There are also risks of hyperstimulation associated with the use of ovulation induction medications such as clomiphene citrate (low risk) and gonadotropin therapy (higher risk). Proper technique and adequate monitoring reduce risks.

The use of fertility drugs brings with it the risk of a multiple pregnancy. In order to reduce this risk, your doctor may stop your cycle midway. The chance of a miscarriage occurring and having a low birth weight baby is high in the case of multiple pregnancies.

Success Rate

In a given cycle, the possibility of conception is 10% to 20% provided the sperm count is good and the female has a healthy fallopian tube. The woman’s age is also a deciding factor on the success rate, since advanced maternal age results in fewer follicles maturing into eggs.

How many IUIs should I try before moving on to IVF depends on what you can afford and what meds you are doing. One might do 3-4 IUIs on Clomid before moving on to injectables, then do 3-4 cycles on injectables. If one doesn't have success after four good ovulatory cycles on injectables with well-timed IUI, it would be time to consider IVF.

IUI can be used for gender selection beacuse sperm can be washed or spun to increase the odds of having a male or female offspring. The techniques aren't 100 percent effective, but perhaps as high as almost 90 percent. There is usually greater success selecting boys.

How much does IUI cost?

This is definitely something to consult your doctor or clinic about as the price varies considerably. The IUI procedure and sperm washing average $200-300. Someone doing a natural IUI cycle may spend only $200, while someone on injectable medications with monitoring may spend $5,000-6,000.