Intrauterine insemination (IUI) is often the first type of fertility treatment attempted by couples.
It's much simpler than other methods of Assisted Conception.
Intrauterine insemination (IUI) also known as Artificial Insemination is the process where a washed sperm sample is deposited in the woman's uterus through artificial means. This process is carried out at around the time of ovulation, with the aim of getting the sperms nearer to the egg. This is a less invasive and more affordable alternative to IVF.
Every individual is born twice as a child & as a parent.
Who might benefit?
- IUI can help couples where the male partner has a low sperm count or poor motility (the ability of the sperm to move), as long as there are sufficient levels of healthy, motile sperm to make the treatment worthwhile
- As sperm is placed directly inside the female's uterus, IUI can also help couples who are unable to have intercourse because of disability, injury, or difficulties such as premature ejaculation
- Also recommended for women with Mild Endometriosis
- Used as the first line of assisted conception treatment for couples with "Unexplained Infertility"
- Depending on your particular fertility problem you may or may not be advised to use fertility drugs alongside the IUI treatment
- If fertility drugs are used it is called a "stimulated cycle" because the drugs stimulate ovulation
- If drugs are not used it is called an "unstimulated cycle" or "natural cycle"
- In unstimulated cycles, IUI is timed to take place at the time of natural ovulation. IUI is usually done between about day 12 and day 15 of a natural menstrual cycle, but the exact day will depend on your particular cycle and when ovulation is detected
- If IUI is scheduled during a stimulated cycle, fertility drugs in the form of an injection and nasal spray are prescribed. You'll start taking the drug near the beginning of your menstrual cycle to stimulate your ovaries to develop several mature eggs for fertilisation. (You normally release only one egg a month.) Doctor will use ultrasound to detect ovulation and make sure that insemination is carried out at the optimum time. You may ovulate naturally, or be given an injection of the hormone hCG (human chorionic gonadotrophin) to bring this on
- Once you ovulate, your partner produces a sperm sample, which is "washed" to extract the best quality, most mobile sperms. Using a catheter through your cervix, doctors then put these sperms directly into your uterus near a fallopian tube (the passage the egg travels along from an ovary to your uterus). This is IUI
- You rest for a short time afterwards and then carry on life as normal
- Pregnancy test can be done to confirm conception after about 2 weeks
In order to get sperms ready for the IUI procedure, semen sample must first be prepared properly according to Sperm Count & Sperm Motility, this process is known as Sperm Washing.
Sperm washing may sound strange, but it actually works to ensure that only the healthiest sperms are used during the procedure thus increasing chances of conception.
- Sperm washing is a procedure used to prepare sperms for use in IUI
- It allows your partner's sperm a better chance for survival and fertilization
- Sperm washing separates sperm cells from a male's seminal plasma, helping to get rid of dead or slow-moving sperm as well as additional chemicals that may impair fertilization
- There are a variety of different sperm washing procedures
- Maintenance of a sterile environment during any ART technique is of prime importance
- Thorough hand washing, use of sterile consumables & media are basic requirements
- It is advised to carry out all ART work under a Laminar Air Flow Hood
- Sperm must be washed in order to be used with IUI
- Raw semen cannot be inserted directly into a woman's uterus as it contains chemicals called Prostaglandins. Prostaglandins cause muscular contractions and are responsible for cramps during menstruation and pregnancy
- If raw semen is inserted directly into uterus, rather than going through the cervix first, it could cause severe pain and cramping. It could also cause your uterus to collapse, causing severe complications
- Sperm is also washed in order to increase chances of oocyte fertilization
- Sperm washing can remove dead sperm and those sperm with poor motility. This leaves behind sperm that can swim faster and that are more likely to fertilize your egg
- Sperm washing can also get rid of the white blood cells, mucous and seminal fluid surrounding the sperm, which can also interfere with fertility
There are three commonly used sperm washing techniques. Selecting the optimal method for a given sample will depend mainly on the sperm count & motility, & the procedure for which it is intended.
Simple Sperm Wash
- This wash technique is the most basic way of washing and preparing sperm for IUI, especially when sperm count & motility is low
- Such sperms cannot withstand high centrifugation speed & time used during other Sperm Washing Techniques or can adversely affect such sperm's survival
Swim Up Technique
- The swim up is very convenient & commonly used technique
- 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
- Method is ideally preferred when sperm count is above 30 millions/ml & contains linear, rapidly motile (also called as Grade A) Sperms
Density Gradient Sperm Wash
- The density gradient sperm wash is one of the most popular sperm washing methods, which is based on differences in density & motility
- Method is preferred when sperm count is very high; but along with more no. of defective or dead spermatozoa. It works to separate dead sperm cells, white blood cells, and other waste products from the sperms
- This procedure can be an effective solution for men with a low sperm count or poor sperm motility, where the sperm can't make the long journey to the egg
- A useful technique for couples who have problems because the man's sperm can't get through the woman's cervical mucus, may be due to an immune reaction
- Only work for couples where the woman has no fallopian tube blockages
- Donor sperms can be used in cases where the man is producing no sperm at all, or where a woman wants to have a baby on her own or she is within a same-sex relationship
- In the latter case, the advantages of going to a clinic for IUI with donor sperms includes, proper screening of the donated sperms for infections such as HIV and hepatitis. The legal rights and responsibilities of the father do not apply if frozen donated sperm is used
- The procedure can be uncomfortable for some women if it proves difficult to insert the catheter and also because IUI can cause cramps similar to period pains
- With stimulated cycles there is also a risk of developing the potentially dangerous condition known as Ovarian Hyperstimulation Syndrome (OHSS). This happens when your ovaries respond too well to the fertility drugs used to induce ovulation. The ovaries rapidly swell up to several times their normal size and can leak fluid into the abdominal cavity, making you gain weight and feel full and bloated
- It is vital that you seek medical help if you think you are experiencing hyper stimulation