Intrauterine Insemination (IUI) is a procedure which is widely used in the management of infertility. It is one of the most preferred treatment before proceeding for IVF or ICSI procedure. In this procedure, the semen sample is washed and instilled inside the uterus at the time of ovulation to improve the probability of fertilisation naturally. This procedure is quite simple, cost effective and gives fair results in may be 3 or 4 cycles in the subgroup which is carefully selected .
Dr Smita Jain, clinical director at Maple Fertility Clinic, practice IUI cycles in carefully selected group of patients who have mild infertility issues and allow them to conceive by natural fertilisation . But if they fail repeatedly or have some serious issues then they are advised to go for IVF or ICSI techniques .
USES of IUI
The technique of IUI is useful in the subgroup of infertility patients who fulfil the following criteria:
Semen analysis of the husband is either normal or mildly deranged. The total motile sperm count in the post wash semen sample should be at least 10 million. In cases of severely altered semen parameters of sperm count, motility or morphology, IUI is not recommended.
The female partner should have at least one open and normal fallopian tube. In IUI procedure the fertilisation happens naturally inside the body, and it is the fallopian tube where this process happens and both gametes (egg and sperm) has to travel inside the tube. So, this procedure will not work if both the fallopian tubes are blocked.
Female partner should have a reasonable ovarian reserve. This is usually assessed by your gynaecologist by doing certain tests like ultrasound and AMH levels . The age of the female partner is also an important considerate .
There should be no active infections in the genital tract of either partners . Some screening test is done for this by your fertility specialist .
Few gynaecological conditions significantly lowers the success rates of IUI and these cases are better treated by IVF. Some of these conditions are severe endometriosis, genital tuberculosis, resistant PCOS, pelvic adhesions etc.
RISKS of IUI
As such there are no absolute risks of intrauterine insemination if done by a qualified fertility specialist. But in certain situations, some adverse effects are seen.
Sometimes IUI done with an infected semen sample can introduce infection inside the uterus cavity. Also the sample needs to be processed under strict hygienic environment and precautions. Women with active genital infections should be treated first and then be posted for IUI.
In few of the cases, the woman develops abdominal cramps due to uterine contractions which are elicited by larger volume of the semen sample being injected or due to irritation of the uterus by seminal prostaglandins or if IUI catheter is placed high up touching the fundus of the uterus. It usually subsides in few hours.
Delaying TTP ( Time to pregnancy )
Doing multiple cycles of IUI in poor selected cases can lead to loss of precious time being wasted for years altogether. All this while the biological clock is ticking and ovarian reserve is being depleted continuously. The lost ovarian pool of eggs cannot be reversed . Therefore one need to discuss the management algorithm of their case on individual basis after the workup of infertility is done. How many IUI attempts to be done and when to proceed for IVF needs to be discussed and talked about. Your fertility specialist would be able to answer that well.
SUCCESS RATE OF IUI :
The average success rate of an IUI cycle is around 10 to 15 %. Intrauterine insemination if done with a very good ovarian stimulation protocol (using FSH injections) and monitoring can yield as high as 20 to 25 % success rate per cycle. Cumulatively ,3 attempts of good IUI cycles are equivalent to one IVF cycle in terms of success rate. Discuss your success rate as per your clinical case profile with your treating gynaecologist .
We at Maple Clinic strongly recommend IUI cycles with ovarian stimulation in our selected group of patients and we have a reasonably good success rate of around 20 % per cycle.
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