An IUI -- intrauterine insemination -- is performed by inserting a very thin flexible
catheter through the cervix (mouth of the uterus) and injecting washed sperm directly
into the uterus. The whole process does not 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. Sometimes when the cervix is hard to reach a tentaculum is used
to hold the cervix, which makes the procedure easier.
Usually the sample is collected through ejaculation by masturbation into a sterile
semen collection container in a private room at the clinic. From the time the sample
is received, it takes about 1 hour 30 minutes to make the sample ready for insemination.
The amount of time may vary depending on the sperm quality, as special techniques
may be required.
Ideally, an IUI should be performed within 6 hours before or after ovulation. Timing
is based on an hCG injection (given to release the egg) and the IUIs are usually
done between 24 and 36 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. Success rates are higher
with two IUIs as compared to a single IUI. The egg is only viable for a maximum
of 24 hours after it is released.
The results vary from centre to centre and may be as low as 6% to a maximum of about
20% per cycle. The low statistics are with one follicle, while multiple follicles
resulted in as high 20 percent success. Another influencing factor is sperm count.
Higher sperm counts increase the odds of success; however, there was little difference
between success with good-average counts and those with high counts. The overall
success rate seems to be between 15-20 percent per cycle. The rate of multiple gestation
pregnancies is 23-30 percent. Our current success rates are > 20%.
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 the
pain of the egg being released (ovulation) rather than from the IUI. The catheter
usually does not cause pain as it is very thin and flexible and the cervix is already
slightly open for ovulation.
Current research indicates that washed sperm can live 24-72 hours; however, it does
lose potency after 12-24 hours. Another issue with IUI is that the sperm can keep
on swimming beyond the fallopian tube, so the ideal window is really within 6-12
hours of the egg being released; with a larger margin before ovulation than after
since the egg's viability is shorter. Sperm can live up to 5 days in fertile mucus,
2-3 days being common, so combining IUI with intercourse may provide better coverage.
We advise patients to lie down on the table for 30-45 minutes after the procedure.
Most people don't need to, but if you had cramping or don't feel well afterward
it makes sense to take rest for a day or two. We advise against any heavy work or
travelling by buses, rickshaws or scooters as the bumpy ride may reduce chances
of conception.
This depends on your individual situation, but it usually should not be less than
3 days and not more than 7 days in order to ensure the best motility and morphology.
We advise that you have an intercourse around the 7th or 8th day of your cycle and
then abstain.
Usually you can have intercourse anytime after an IUI. We suggest waiting 48 hours
to resume relations if you had any bleeding during the IUI or if a tentaculum is
used.
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.
According to different studies, 3-4 follicles gives one the best chance of getting
pregnant, while more follicles beyond that simply increases the risk of multiples.
IUI can help patients taking only tablets containing clomiphene citrate where cervical
mucus is a problem, and IUI increases the chance of success in patients on injections
no matter what the sperm count. It does make sense to try IUI if you have tried
but haven't had success with intercourse. It is important to note that with intercourse,
only the best and strongest sperm make it through the cervical mucus and up into
the uterus and fallopian tubes. With IUI, more number and better quality of sperms
are available for fertilization.
A count above one million (after sperm preparation) appears necessary for success,
with a significant reduction in pregnancy rates when the inseminated is count is
lower than 5-10 million (in other words, in most cases one should consider 5 million
a lower limit for success, 10 million for cost-effective). Higher success rates
are with washed counts over 20-30 million, while increasing counts over 50 million
did not appear to offer advantage.
It depends on what you can afford and what medication you are taking. One might
do 1-2 IUIs on Tablets 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. Age is also a factor, the higher
the age, the more aggressive is the treatment required.
An IUI shouldn't be done at home without medical supervision because the sperms
needs to be washed to prevent infection -- i.e., separated from the semen. A vaginal
insemination can be done at home, but is no more successful than intercourse. Getting
semen or air into the uterus could be quite dangerous -- perhaps life-threatening.
It doesn't usually happen, but it isn't uncommon. Some women also have light bleeding
with ovulation.
Implantation takes place 6-12 days after ovulation - so 6-12 days after a well-timed
IUI.
The IUI procedure and sperm washing and ultrasonography cost Rs. 4000, but the cost
of medications can make a considerable difference. Someone doing a natural IUI cycle
may spend only Rs. 4000, while someone on injectable medications with monitoring
may spend Rs. 7000 to 8000.
Transvaginal Ultrasonography is done from Day 10 or 11 of the menstrual cycle to
note the growth in follicular size and look for signs of ovulation like reduction
in size of follicle, fluid in POD etc.
Follicles are usually considered mature once they have achieved a size of about
18 mm. Also, follicles continue to grow until they release, usually at a rate of
about 1-2 mm per day. A woman may ovulate more than one follicle in a cycle, but
the releases will occur within 24 hours. When hCG is not used, only follicles close
in size are likely to release. The use of hCG induces ovulation in about 95 percent
of women, and will get most mature follicles to rupture.
The main risks are some discomfort such as cramping, minor injury to the cervix
that leads to bleeding or spotting. 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.
Most women don't need medication for pain associated with IUI. If there is cramping,
it is best to avoid medications such as ibuprofen and naproxen (NSAIDS), but paracetamol
is considered safe (but maybe not that helpful for cramps).
It is sometimes also called sperm preparation or spinning. It is a laboratory technique
for separating sperm from semen, and separating motile sperm from non-motile sperm,
for use in assisted reproduction (IUI, IVF). There are various techniques used to
try and separate the 'good' from the 'bad' sperms as well as improve the quality
of the 'not so good' sperms.
No. A tubal ligation is effective birth control because it prevents the sperm and
egg from meeting. The process that leads to pregnancy is having an egg released
from a follicle in the ovary and then beginning the journey to the uterus through
the fallopian tube. Sperm will travel from the vagina, through the cervix, through
the uterus, into the tube where fertilization occurs. IUI bypasses the need for
the sperm to travel through the cervix, but that's it. It doesn't get the egg to
the other side of the obstruction, so fertilization won't take place. The only way
to get pregnant after tubal ligation or blocked tubes is by having reversal surgery
or an assisted reproduction technology that includes egg retrieval, such as in vitro
fertilization (IVF).
In case of any doubts contact your doctor or Gouri at Care IVF.
Instructions before IUI
- Some antibiotics are given in the initial part of treatment to take care of infections.
It is important that both partners take the medications. Make sure you understand
correctly, what medications are required to be taken.
- For your convenience, injections are available at the Centre at wholesale rates.
There is however NO COMPULSION that you have to buy medicines from the centre.
- Sub cutaneous injections should be given under the skin, either on the forearm or
the thigh. Spirit should not be used to clean the area.
- It is important that you and your partner 'stay together' on either Day 7 or day
8 of the periods so that the semen sample on the day of IUI be between 3 to 7 days
old.
- Once the eggs are mature (average of 18 - 20 mm size), an hCG injection would be
given to you to release the mature eggs. If at any point of time after the injection
you feel any pain in the lower part of your tummy, call the doctor immediately.
The IUI may need to be re scheduled.
- IUI does not require any admission in the Nursing Home. However, do come with 2-3
hours in hand.
- Inform the Centre once your periods start so that a booking for Follicular Study
(Ultrasonography) can be made on Day 2 and then again on Day 10. If it happens to
be a Sunday, come on Saturday, not Monday.
- After IUI, a medication needs to be inserted vaginally twice a day. In the morning,
lie down for one hour after the insertion. At night, insert at the time of going
to bed. Some of the medication may come out in a liquid form, do not get alarmed.
Information of certain Drugs used in IUI cycles
-
Aspirin (Ecosprin75mg)
Low dose aspirin treatment is started either from the D1/D2 of periods or immediately
after IUI. This enhances blood flow in multiple different organ systems. Studies
have shown dramatic improvement in follicle development, pregnancy rates and implantation
rates. ( Rubinstein et al; Fertil Steril 1999; 71: 825-9).
-
Progesterone (Naturogest/Micpro)
Progesterone hormone is produced after the follicle ruptures and releases the egg.
This hormone supports the lining of the uterus and prepares it to receive the fertilized
egg, i.e. the embryo. This phase after rupture of the follicle till the next periods
occur is called the Luteal phase. Some women have a natural defect in their luteal
phase which is aggravated when drugs like Clomiphene Citrate (Siphene) are given
or when extensive down regulation is done as during IVF (with drugs like Lupride).
Thus after IUI, progesterone supplementation is done to provide extra care and support
to the lining of the uterus as well as reduce the irritability of the uterus to
increase chances of pregnancy.
-
Anti-Oxidants (Genew or Lycored)
Stress, Smoking, Excess Alcohol and Environmental pollution lead to generation of
ROS or Reactive Oxygen Species that cause damage to sperms and oocytes. Anti Oxidants
reverse this to some extent and have been shown to increase pregnancy rates.
-
Estradiol (Progynova)
Estradiol is responsible for increasing the lining of the uterine cavity. As the
level of the hormone increases you will find the ET or Endometrial thickness increasing
on the folliculometry scan. Sometimes due to drugs, some hormonal problems or idiopathic
reasons, the lining does not develop well. In these times, Progynova supplementation
at the right time helps correct the problem.