Intrauterine insemination (IUI) is  a  simple and cost effective fertility treatment.In this procedure healthy sperm is placed into a woman’s uterus when she is ovulating. This procedure is used for couples with unexplained infertility, minimal male factor infertility, and women with cervical mucus problems. IUI success is improved when it is done in conjunction with ovulation-stimulating drugs. It can be performed using the husband’s sperm or donor sperm. Before the procedure, the woman should be evaluated for any hormonal imbalance, infection or any structural problems.

Factors for a successful IUI programme :

  • Healthy sperm (Sperm count, motility and morphology should be good)
  • Timing of IUI – for a healthy pregnancy the sperm and egg should meet within 24 hrs. of ovulation. An aged or degenerated egg cannot yield a healthy pregnancy.
  • Fallopian tubes should not have any blockage or obstruction.
  • Similarly, the quality of egg should be good, an egg with thick covering(zona) does not allow sperm to enter inside the egg.
  • The uterus should be prepared well to receive the embryo otherwise implantation does not happen.

When is IUI used?

The most common conditions where IUI is recommended :

  • Low sperm count or decreased sperm mobility.
  • Unexplained infertility
  • A hostile cervical condition, including cervical mucus problems
  • Cervical scar tissue from past procedures which may hinder the sperms’ ability to enter the uterus
  • Ejaculation dysfunction

The success rate in  IUI :

The success of IUI depends on several factors. If a couple has the IUI procedure performed each month, success rates may reach as high as 20% per cycle depending on variables such as female age, the reason for infertility, and whether fertility drugs were used, among other variables.

Pregnancy rate :

Approximate pregnancy rate as a function of total sperm count ( maybe twice as large as total motile sperm count). Values are for intrauterine insemination. The pregnancy or success rates for artificial insemination are 10 to 15% per menstrual cycle using ICI, and 15–20% per cycle for IUI. In IUI, about 60 to 70% have achieved pregnancy after 6 cycles.

However, these pregnancy rates may be very misleading, since many factors, including the age and health of the recipient, have to be included to give a meaningful answer, e.g. definition of success and calculation of the total population. For couples with unexplained infertility, unstimulated IUI is no more effective than natural means of conception.

INSEMINATION PROCEDURE

Speculum
1 cc sterile syringe with blunt cannula
Disposable polyethylene insemination catheter
Two types of catheters
Relatively rigid single sheath catheters (straight or with a preformed curve) that cannot be bent
Double sheath catheters with an external flexible sheath that will maintain a curve and a very soft internal catheter.

PREPARATION BEFORE PROCEDURE

full bladder {facilitate straightening of the uterus}.
Lithotomy position
The cervix is exposed with bivalve speculum & rinsed with saline
The catheter is firmly connected to the cone of 1cc tuberculin syringe Plunger is withdrawn slightly & the sperm suspension is then aspirated from the test tube into the catheter without any air bubbles. Sperm is suspended in a small volume of media, no more than 0.5 mL {prevent expulsion or reflux from the cervix and uterine contractions after it is inseminated into uterus}.

HOW IUI IS DONE?

The catheter tip is advanced to a depth of approximately 6 to 6.5 cm. Try not to let the catheter touch the fundus {cramping and, in some cases, disruption of the endometrium and bleeding: toxic to embryo development}.
If catheter passage through the cervix is difficult: grasp the cervix with tenaculum to straighten the utero-cervical angle by gentle traction
Inject the sperm Leave the catheter in place for short time withdraw it slowly {avoid suction effect & prevent reflux}. Sperm are present in the fallopian tubes as early as 5 min after insemination
Patients rest in supine or reverse Trendelenburg position for 10 min {higher PR in rested patients compared with those who were immediately mobile post IUI} (PR 25% vs 10%).

POST PROCEDURE CARE
The patient may resume her normal activities after insemination.
Increased wetness after the procedure { loosened and watery cervical mucus} does not mean the sperm specimen has flowed out patients should be reassured about this.
Abdominal cramping or discomfort may; acetaminophen
Light bleeding or spotting
Intercourse within 12-18 h If they wish to do so
Pelvic discomfort {ovarian enlargement from CC or Gnt}: No intercourse.
A urinary or serum pregnancy test 2 w after IUI. If the patient has received hCG for ovulatory triggering, it is important to inform the patient that a urinary or serum pregnancy test may remain positive up to 12 days after the injection.

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