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Intra Uterine insemination (IUI)

IUI Stands for Intra Uterine Insemination. It is a procedure that involves placing sperm inside a woman’s uterus to facilitate fertilization. The doctor uses a catheter to place a number of washed sperm directly into the uterus. The goal of IUI is to increase the number of sperm that reach the fallopian tubes and subsequently increase the chance of fertilization.

  • IUI is one of the most common and easy fertility treatments.
  • The treatment is not expensive at all, even considering any hormone injections that may be prescribed for the woman
  • There are very minimal or no side effects – no pain, no after effects
  • Over multiple cycles, it has a reasonable success rate

Doctors may suggest IUI as a treatment option if any of the following conditions are true

  • Unexplained infertility
  • Ovulation Problems
  • Low sperm count
  • Decreased sperm motility
  • Requirement of donor sperm
  • A hostile cervical condition, such as cervical mucus that is too thick
  • Cervical scar tissue from past procedures or endometriosis
  • Ejaculation dysfunction

The following processes have to be followed before IUI treatment is undertaken

  • Patency of the fallopian tubes – Doctors have to ensure that the fallopian tubes of the woman are open and healthy. This can be done through HSG, SSG, Laparoscopy etc.
  • Ovulation is normal – Using scans and other lab investigations, doctors will ensure that the ovulation process is smooth and healthy. If not, that will have to be treated.
  • Potency of the Semen – Through a proper semen analysis of the male, doctors will ensure that the semen parameters are acceptable for IUI – motility, count etc.

Depending on the particular fertility problem, The doctor may need to use fertility drugs in the IUI treatment. If fertility drugs have been prescribed, it’s called a stimulated cycle, because the drugs stimulate ovulation. If drugs are not used it’s called an unstimulated cycle, or natural cycle.

In an un-stimulated cycle, IUI is timed to take place at the time of natural ovulation. The doctor will track the period cycle using blood tests and ultrasound scans. IUI is usually done between day 12 and day 16 of a natural menstrual cycle, but the exact day will depend on the individual cycle.

If the doctor has planned a stimulated cycle, the patient will be given fertility drugs in the form of tablets or injections. These drugs are taken from the beginning of the menstrual cycle to stimulate the ovaries and to develop several mature eggs for fertilisation. This is different from the usual one egg per month that happens in a natural cycle.

An ultrasound scan helps to locate the egg and check that it is mature. This will allow insemination to take place at the best time. Ovulation may have occurred naturally, or through an injection of a hormone called human chorionic gonadotrophin (hcg).

Processed sperm from the male partner is then inserted into the uterus within 24 hours and 40 hours of the hcg injection, or when there is a rise (surge) in luteinising hormone (LH). The husband will be asked to provide a sperm sample which will be washed to extract the best quality and most mobile sperm.

Using a catheter (tube) through the cervix, the doctor will then put this sperm directly into the uterus near a fallopian tube. This is the passage the egg travels along from an ovary to the uterus.

In case of unexplained infertility, the sperm may be inserted within a larger volume of fluid than usual. This allows it to wash up into the fallopian tubes more easily (fallopian sperm perfusion). This technique takes a few minutes more than standard IUI and may increase the chance of success.

After IUI, the patient needs to rest for a short time (about 30 minutes) and then carry on life as normal. A pregnancy test is to be done after two weeks.

  • Follow all the instructions given by the doctor.
  • Ensure all medication and injections are taken as per doctor’s advice. This includes the date and time of medications.
  • The husband has to ensure abstinence of a minimum of 3 days and maximum of 7 days before the semen sample is given.
  • Work towards reducing stress levels. Stress has a huge bearing on the success rates. Yoga, pranayaama, meditation, light music, exercise etc. helps a lot. Talk to your doctor if you need counseling on any of these aspects.
  • Follow all the instructions given by the doctor.
  • Ensure all medication and injections are taken as per doctor’s advice. This includes the date and time of medications.
  • Do not travel in two wheelers or autos over long distances.
  • Do not climb stairs or indulge in heavy work or exercise for the first week.
  • Ensure that there is no stress. Stress has a direct effect on the hormones which may then have a negative effect on the conception.

On the day when the IUI procedure has been posted, the husband needs to give a semen sample. Processing the semen takes about 60 – 90 minutes. Once the semen sample has been prepared, the actual IUI process takes less than 15 minutes. Once the insemination is done, the patient needs to rest for 30 to 45 minutes.

Considering all of the above, the patient needs to plan for being at the hospital for 3 hours including the time taken for semen collection.

Women under the age of 35 usually have higher rates of success than women over age 35, but the average success rate for IUI ranges from 10-20% in one cycle. With IUI, as with other methods of artificial insemination, the success rate depends primarily on the health of both the sperm and the woman.

If the previous IUI cycle has not resulted in a successful pregnancy, please consult the doctor. The doctor may proceed based on these lines

  • Additional blood investigations may be done to ensure all hormone levels are within the required limits
  • Identify the cause for the failure (if possible). If identified, treatment program may be put in place to address the cause.
  • Doctors may suggest another cycle of IUI.
  • If more than 3 – 4 cycles have not yielded a positive result, the doctor may recommend other options, including IVF.
  • If the doctor feels that the cause may be due to male factors, the doctor may suggest a cycle of donor IUI. Donor IUI is the same IUI process done with the semen of an anonymous donor. This is done only if the couple provide written consent for the same
  • The male partner needs to provide a semen sample at short notice. Generally, this can be planned. But there may be instances where ovulation occurs unexpectedly and so the semen sample has to be provided for processing and insemination. Some patients may find this uncomfortable.
  • Few patients are unable to give a semen sample within the hospital premises, due to stress and anxiety. In such cases, semen sample will have to be collected at home and delivered within a short time. This may be a challenge based on the time needed to come to the hospital.
  • If it is a stimulated cycle, there is a chance that the patient may go into OHSS (Ovarian Hyper Stimulation Syndrome). In this, the ovaries become over active. In such cases, there may be abdominal pain and ovaries may get bloated. This can be handled effectively through medication.
  • Success rates of IUI per cycle, is not very high. If a cycle does not succeed, patients may feel disappointed and depressed.

Cost is Rs.7,500 to 10,000 per insemination

  • Semen processing.
  • IUI insemination procedure.
  • Ultrasound test for monitoring follicles, uterine evaluation.
  • Consultation charges are excluded in the procedure price.
  • Donor semen charges if needed
  • Medications and injections that may be required
  • Blood monitoring tests of follicle development and other investigations
  • Only primary specialist included in package. Other specialist visits if required is additional.
  • If IUI has to be performed under General Anesthesia, charges for OT and anesthetist is extra
  • If doctor suggests a second insemination due to egg rupture delays, within same cycle, additional charge of Rs.3,500 is levied