Sometimes, couples may need a little help conceiving. There are many different types of fertility therapies available. Intra-uterine insemination or IUI is a simple fertility treatment that involves inserting the sperm directly into a woman's uterus while she is ovulating. It may also be performed with donor sperm or frozen sperm.
Who Can Benefit From IUI?
IUI may be recommended:
- For ovulatory disorders such as PCOS
- For minimal or mild endometriosis
- In the cases of mild male infertility
- If a sperm donor is being used
- Hostile cervical mucus
- Very painful sexual intercourse
- Unexplained reasons for infertility
- Simpler forms of fertility treatment are not successful
However, it is not recommended when the woman has:
- A severe fallopian disease or blocked tubes
- Moderate to severe endometriosis
- Very low ovarian reserve
- Women over age 40
- Severe male factor infertility in such cases ICSI is a better option, unless the IUI is planned with donor sperms
IUI is usually preceded by oral or injectable fertility medication. As the menstrual cycle progresses, serial ultrasound scans or follicular monitoring are carried out. The doctor may schedule a date for the IUI procedure if she is monitoring ovulation or ask the patient to use a home ovulation kit and come to the clinic when she is ovulating.
The first step to IUI is preparing the sperm. This sperm could be:
- From the husband or an anonymous sperm donor, as the case may be
- When it is the husband's sperms, they may be collected fresh by ejaculation just prior to the procedure, or frozen beforehand in case of him being unavailable on the day of IUI
- In case of donor sperms, we always use frozen samples as they need to be quarantined before use
In all the above cases, the semen sample will be put through a special washing procedure which isolates the sperm and removes impurities. A catheter will be fitted into the woman's cervix. This is not a painful process but may cause mild cramping in rare cases. The concentrated sperm sample will then be transferred to the uterus through the catheter. Thus, it does not have to swim through the cervical mucus and can directly reach the egg.
Hospitalization is not required for this procedure. After the procedure, the woman may be prescribed progesterone suppositories. A pregnancy test is advised 15-17 days after the procedure.
IUI is a relatively low-risk procedure. Some women may develop ovarian hyperstimulation syndrome (OHSS). However, complications such as OHSS or infections are extremely rare. Women who are prescribed gonadotropins before the procedure may develop too many potential follicles. If the procedure is conducted on these follicles, there is a high risk of multiple pregnancies. Hence, in such cases, the cycle may be cancelled and the woman may have to start taking the medication again during her next menstrual cycle. Another alternative is to convert the IUI cycle to an IVF cycle, where the follicles will be aspirated thereby reducing the risk of OHSS or multiple pregnancies.
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