What is Intrauterine Insemination (IUI)?

IUI, medically known as intrauterine insemination, is a simple form of fertility treatment. The doctor can perform it either with or without medication. The medical modus operandi includes the procedure of transferring semen to the uterus through a thin catheter. However, before proceeding with it, the doctor will need to wash and concentrate on the semen.

This way, it will be much more effective and powerful. A doctor will most likely perform IUI treatment during ovulation. But if he/she has to do so before the same, then they might use the drugs.

The doctor can use IUI to subdue the symptoms or treat various types of infertility issues. In most cases, he/she will perform the same in multiple cycles until the couple conceives. Also, almost every infertility specialist proceeds with this procedure first before moving onto something more invasive, like IVF.

The following are some of the situations where doctors tend to opt for IUI.

• Unexplained Infertility: Even after running several diagnostic tests, the doctor might not be able to determine the actual cause of infertility. So, in that case, he/she will opt for IUI alongside injecting the ovulation-inducing drugs.

• Donor Sperm: Most physicians usually use IUI for those women who do require the sperm of a donor. During the procedure, the frozen sperm is obtained from a well-known and certified lab. This is something where the bank has to obtain a government license, and only then should you be able to procure sperm. The sample, which is available from an ART bank, is usually going to be matched for height, weight, religion, skin colour, and hair colour. In certain situations, additional characteristics like educational qualifications and blood group are also taken into consideration with the new ART law. In place. The couples in India are allowed to choose known sperm donors as well.

• Endometriosis-related Infertility: In the case of endometriosis-related infertility, the doctor would, first, try to obtain a high-quality egg. Once he/she gets it, then they will perform IUI to make it fertile.

• Cervix-related Infertility: During the period of ovulation, the cervix tends to create a high amount of mucus to prepare a proper environment for egg production. However, due to some medical reason, the cervix of some women cannot produce mucus at all. This, in turn, leads to infertility. So, in this aspect, the doctor will need to find the underlying disease and treat it before moving on to IUI.

• Semen Allergy: In rare cases, a woman can suddenly become allergic to a specific type of protein available in semen. Thus, in this aspect, ejaculating into the vagina of women could cause redness and itching in the area. The use of a condom might help you to prevent this issue.

However, this way, you cannot have a child as well. Thus, if your sensitivity to this allergic reaction is excessive, then it would be better for you to choose IUI. During this procedure, the doctor would remove many components from the semen. So, it should be safer for you.

There are several health indications that might suggest the need for the IUI procedure.

• Unexplained infertility

• Male sexual function disorders

• Borderline, but lower semen parameters; in fact, it is this category of patients who are going to benefit the most from the treatment of IUI

• It is also ideal to make sure that the female partner’s parameters are absolutely normal

• Couples who are undergoing IUI will have the best outcome if the age of the partners is less than 37 years of age

• Social indications, especially in a country like India, where a lot of males are working in the merchant navy or in the Indian defense army or the Indian navy, where they have to stay away from their home for a prolonged period of time, can be very strong. Consider the option of doing sperm banking with a fertility unit like ours, which specialises in that, and it is these frozen sperm that are then utilised for doing IUI with the husband’s sperm in the absence of the husband, so that the time to conception and time to pregnancy for the couple cannot be delayed.

The IUI procedure is seemingly simple and painless. However, as a first-timer, you might feel a bit nervous. Thus, knowing about the process can help you to prepare for it in a proper manner. So, let’s take a look at it as well!

Step 1

Collection of the Semen: During the earliest stage, the doctor would collect a small amount of sperm for the procedure. It can be acquired through masturbation, almost similar to the process of semen analysis.

Nevertheless, if your partner is unable to produce the same at the hospital, then he can do so at home. In this case, the doctor will provide him with a sterile semen collection kit. But the sample needs to arrive within an hour after the ejaculation.

Step 2

Semen Washing: The semen of a human being contains much more than sperm. Besides, it also comprises protein, vitamins, and some other crucial components. So, before beginning the procedure, your doctor will remove the unnecessary parts from it. This is known as the washing procedure!

Two of the most common techniques used here in order to do something called sperm preparation include the swim-up technique and the double-density gradient technique. Both preparation methods have their specific indications, and both find a variety of applications in a fertility unit.

We prefer to predominantly use the swim technique for the preparation of sperm, especially if the DNA fragmentation index, or DFI, of the sample is considered to be normal

We prefer to keep the incubated sperm for approximately two hours prior to pushing them inside the uterus. This is mainly because acrosomal activation occurs in this window, which allows for a quick fertilisation if the window matching has been done correctly.

The ideal time to do your IUI treatment is approximately 40 hours after the trigger.

The choice for giving the trigger is almost always going to be injection of HCG 10,000 IU for the majority of the patients, and we do not prefer to use any other form of trigger because it is the HCG that gives the most important and effective outcomes without disturbing the endometrial synchronization.

We absolutely do not prefer to use an agonist trigger for any of the patients who are undergoing IUI cycles

A lot of patients who come to me are often under the impression that doing something called an IIUI is going to be better than actually doing a single IUI. Now, in this situation, I want to inform each and every one of you that after the trigger for HCG 10,000 has been given to the patient, the ovulation would usually occur after approximately 38 to 42 hours.

IUI typically involves doing the first IUI approximately 12 to 16 hours after the trigger and the second IUI approximately 36 to 42 hours after the trigger.

As a result of this, the sperm, which has been prepared and has been pushed inside the uterus in the 12  to 14 hour window, will actually find no egg to undergo fertilisation, and as a result of this, there is absolutely no benefit to the patient of doing any form of IIUI in a routine practice if you are visiting a good fertility unit.

All the patients who have undergone IUI with us will have the luteal phase support, which is a standard in the form of either the fast tablets or in the form of a progesterone gel. 8%, which is to be inserted inside the vagina for the next 14 days once a day.

Certain situations where the male partner can have an elevated DFI. We prefer to use the microfluidic chip in order to process the sperm, and the sperm that then comes out is then used for either the process of ICSI or the process of IUI.

Here, it is also extremely important for everybody to understand that the success rate of using a frozen semen sample is as good as a fresh semen sample. In a busy unit like ours, we use a tagging system to make sure that the sperm sample, which is preserved for a patient in a specified tank, never gets mixed with anybody else’s sperm sample, allowing our patients to maintain the integrity of the treatment.

Step 3

Insertion of the Catheter: Now, you will have to lie down on an examination table and put your legs up on the stirrups. The doctor will, first, attach a sperm-filled vial to a catheter and insert a speculum into the vagina.

Then, he/she will insert the catheter into your uterus through the cervical opening. After that, he/she will push the sperm sample into the uterus through the small and thin tube. Once they have done it, they will remove the catheter and speculum, respectively. This procedure can take approximately 6 to 10 minutes to complete nicely.

As mentioned before, the Intrauterine Insemination procedure is absolutely painless. If you already know about the procedure, you will not feel anything during the same. You might feel a small amount of discomfort while the doctor is inserting the catheter. But that’s negligible.

So, once the procedure is complete, the physician will request that you lie on your back for some moments. During this period, the sperm will try to find a way to reach their destination.

After the doctor says so, you can get up and move on to your daily business. You might experience spotting during the first one or two days. But it is temporary and will go away soon on its own. Be sure to wait for at least two weeks before undergoing a pregnancy test.

1. No type of bed rest is warranted after the procedure.

2. Patients can go back to their office on the same day of the procedure.

3. It is widely important for the patient to understand that they must try naturally, even if they undergo the procedure for IUI, as it is important to maintain a steady-state concentration of sperm in the female reproductive system for conception to occur.

The IUI procedure is relatively straightforward and simple. Hence, it does not cause any kind of side effects at all. But there are some risks that might occur under a few special circumstances. These include—

• Spotting: Sometimes, during the procedure, the placement of the catheter can cause vaginal bleeding. But it will be minimal and will go away within one or two days.

• Infection: There is also a minute risk of experiencing an infection on the outer side of the vagina. However, in most cases, the doctor will get rid of it during its earliest stage.

The technique in which the sperm preparation is done makes a huge difference for giving the success rate as well as the complication rate for a procedure like IUI.

The success rate of IUI generally depends on the overall health and efficiency of the sperm. Most women have a 10%-15% chance of success after one cycle of IUI. However, the rate increases to around 60% after three to six cycles of the same.

For IUI treatment, you need to consider several factors. There are several things you need to consider, such as the age of the couple, their medical history, and their type of infertility, to determine the actual fertility cost. The cost of IUI varies from state to state in India.

However, the cost of the same generally ranges from INR 25,000 to INR 35,000 on average, especially if injectable medications are included as a part of the package. In general, IUI is less expensive than other fertility treatments such as in vitro fertilization (IVF).

However, quite a lot of couples who are actually trying for IUI may require trying the treatment for approximately 3 to 4 months, so if you try to calculate the cumulative cost of doing the procedure as a patient, you need to keep your scope a little broad, especially if you plan to go to a good clinic for doing the treatment.