When a woman conceives naturally, sperm travel from the vagina through the cervix into the uterus, and then into fallopian tubes. If sperm arrive in the tube soon after the release of the egg from the ovary (ovulation); the sperm and egg can meet and unite (fertilization) in the tube. The cervix naturally limits the number of sperm that enter the uterus. This means that only a small percentage of the sperm in the ejaculate actually make their way into the fallopian tubes. Intrauterine insemination (IUI) is a procedure that places sperm past the cervix in the woman’s uterus around the time of ovulation. This makes the passage to the fallopian tubes much shorter. The rationale is that increasing the density of both eggs and sperm near the site of fertilization which will increase the likelihood of pregnancy. The likelihood of pregnancy is 3 times greater with IUI as compared to timed intercourse.
IUI
Oocyte Retrieval
ICSI
IUI with partner's sperm can be used as a potentially effective treatment for infertility of all causes in women under the age of 40, except for cases with tubal blockage, severe tubal damage , very poor egg quality, ovarian failure (menopause), and severe male factor infertility. The main indications for IUI are unexplained infertility, mild to minimal endometriosis, cervical stenosis or scarring of the cervical canal, problems with sperm deli very as in erectile dysfunction or premature/retrograde ejaculation, anovulation, fertility preservation mild sperm defects and third party reproduction which involves sperm donation.
IUI steps
Selection + counseling
Ovulation induction
Ultrasound to monitor follicular growth and endometrial thickness
Timing of insemination with ovulatory trigger
Semen preparation
Procedure of insemination
Sperm preparation helps to obtain best quality sperms from the ejaculate by removal of by non-motile spermatozoa, leucocytes and immature forms, seminal plasma which contains prostaglandins & antigenic proteins responsible for contraction and cramps and seminal plasma microorganisms that might induce inflammatory process. Sperm processing also decreases release of lymphokines and/or cytokines and formation of free oxygen radicals causing functional demise of spermatozoa and sperm oocyte interaction. Final Result of semen processing is to obtain enriched fraction of motile and morphologically normal spermatozoa with better fertilizing ability.
The semen for IUI is usually collected by masturbation into a sterile glass or plastic cup that is provided by the doctor’s office or andrology laboratory. Once collected the semen sample is processed using either swim up or density gradient technique. Selection of procedure is individualized depending on count, motility, morphology, source of sample and whether debris & other cellular contamination is seen. Once the sample is given it takes about a total of 2 hours for the preparation until insemination.
The IUI procedure is relatively simple and takes only a few minutes once the semen sample is ready. The woman lies on an examining table and the clinician inserts a speculum into her vagina to see her cervix. A catheter is inserted through the cervix into the uterus and the washed semen sample is slowly injected. Usually this procedure is painless, but some women may have mild cramps. Some women may experience spotting for a day or two after the IUI.
Risks of IUI
If a woman is taking fertility medications to increase the number of eggs when she has an IUI, her chance of getting pregnant with twins, triplets, or more is greater than if she were not taking fertility medications. There is no increase the risk of birth defects after IUI. The risk of developing an infection after an IUI is small.
Success with IUI
The success of IUI will vary depending on the underlying cause of the infertility. IUI works best in patients with unexplained infertility, women with cervical factor and when men are unable to ejaculate effectively. IUI does not work as well for men who produce few sperm or have severe abnormalities with their sperm parameters and also is of no use in presence of severe fallopian tube disease, moderate to severe endometriosis, or a history of pelvic infections. The pregnancy rate with IUI vary from 10 – 18%. The success rates of IUI depends on the age of the woman, whether fertility medications are used and infertility diagnosis.
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