What is Intrauterine Insemination (IUI)?
IUI involves the placing of prepared sperm from your husband high into the uterus (womb) by means of a small plastic catheter. This insemination procedure is timed to coincide with the time of egg release to increase the chances of pregnancy.
What are the indications for IUI?
- Couples having unexplained infertility-ie where all the standard tests in the couple are normal and still the couple are not successful in achieving a pregnancy.
- Mild abnormalities in the sperm parameters such as slightly low count, low motility and morphology.
- Coital Difficulties
- HIV, Hepatitis B/C discordant couples
What does the treatment process involve?
There are several steps which include
- Ovarian stimulation - In an IUI cycle, by giving clomiphene tablets or hormone injections the ovaries are stimulated with a view to produce more than one egg to improve the chances of pregnancy.
- Monitoring egg growth with ultrasound- Each follicle is a small fluid filled sac containing the egg and its growth in response to the medication is monitored with scans. These are internal (trans vaginal ) scans. You might need three or four scans over the course of one treatment cycle.
- Egg release- When 1 - 3 follicles reach the mature size (i.e. measure more than 18mm in diameter on ultrasound scan) an injection called HCG is administered which will cause ovulation to occur approximately 36 hours later.
- Insemination- Insemination is usually performed the day after the HCG injection.The healthy and best swimming sperm are separated from the semen by special preparation techniques and used for insemination. The prepared sperm are kept in the incubator until ready to be inseminated. The insemination procedure is not painful and usually takes about 5 minutes. The sperm is kept high into the womb using a fine soft tube called a catheter. You are advised to lie down for 15 minutes following the procedure.
- Luteal Phase- Usually progesterone tablets are prescribed for supporting the womb lining following the IUI procedure for about two weeks. You do not need complete bed rest for the following 2 weeks and you can carry on with your routine activities as usual.
- Follow Up- You will be advised to attend the clinic in 2 weeks time for a pregnancy test to confirm whether you have achieved a pregnancy or not. However, if you get your periods by that time the treatment has not worked for you and the next cycle of treatment can be started on the 2nd day of the period. If your test is positive you must continue taking the progesterone support until the 12th week of pregnancy. An ultrasound scan can be performed after two weeks to confirm that the pregnancy is developing normally in the womb. After three cycles if no pregnancy has been achieved it is important to discuss further treatment options.
Success of IUI
In general, with one cycle of IUI the pregnancy rate is around 15%. Upto 6 cycles of IUI could be tried before moving to IVF though most of the pregnancies resulting from IUI occur within the first 3-4 cycles of IUI treatment.
DR.S.VYJAYANTHI MD, DGO, DNB, MRCOG (London), MSc (Embryology) (UK)
Head of Department and Consultant in Infertility, Reproductive Medicine and Surgery
Krishna Institute of Medical Science