June 06, 2019 By Dr Arockia Virgin Fernando
What’s there in an IUI?
Intra Uterine Insemination is the most frequently done
assisted conception technique.
It is the deposition of washed and concentrated semen
sample inside the uterus to overcome the natural barriers for the passage of
sperms into the uterus after natural intercourse.
IUI is the first line of treatment of infertility
provided there are sufficient sperms and no tubal disease.
I think this should invoke some interest in you
So is this unnatural?Not at all.We are just helping the
sperms to reach the egg faster.The egg would be inside the fallopian tube
waiting for the sperms.
What is the work up prior to IUI:
ultrasound for the wife
one normal tube confirmed by HSG(Hysterosalphingogram)-tubal testing by
inserting a dye inside the uterus and taking X rays.
- The first visit is when the menses
starts,a scan is done.
tablet called Letrozole or Clomifene citrate is started for 5 days with or
without combination of injections.
next visit is for a scan on day 11 or day 12.
scan will show 1 or 2 follicles 18 to 20mm in diameter.
may be a need for 2 or 3 sittings for scans.
shot is given and IUI is done 36 hrs to 38 hrs later.
motile sperm count should be 5 to 10 million.
catheter is used for insemination into the uterus in the lying down position.
rest for 10 to 15 mins post procedure is advisable.
well timed IUI will give good results.
atraumatic technique is important.
should be performed as soon as possible just after processing and within 90
minutes of collection to optimize the outcome
couple is advised to have intercourse the next day as the egg lives for a
little more than 24 hrs.
hormonal tablets are given from the second day after IUI for 15 days.
date is given for Beta hcg,which is the pregnancy test.
This is all about the procedure.It is less cumbersome.
Why should one go for iui?
cervical surgery or infections
of atleast 3 naturally tried cycles.
than 5 years of infertility
When IUI should not be done?
than 1 million sperm count in postwash semen
Critical factors for success are:
the Insemination accurately
wash total motile sperms
Pros and Cons of IUI?
|First line treatment||Limited indications|
|Simple and easy||Low success rate|
|Less invasive||Ovarian hyperstimulation|
|Less psychological burden|
The clinical pregnancy rate in one cycle of IUI is
between 10% to 20%.
The pregnancy rate is only so much because we have no
control over the fertilisation of the egg and sperm.That has to happen
The reason for wide variation in success rate may be
due to varied indication,duration of infertility,different stimulation
protocol,no of IUIs etc
When to end this?
3 to 4 cycles of IUI are recommended before moving on
Certain Facts about IUI:
is a poor treatment option for women over 40 yrs due to negligible pregnancy
rate.It is better to move to higher form of treatment for women over 35 years
and longer duration of infertility due to the age related decline in success.
should not be done if there are more than 3 big follicles.
guided IUI offers no benefit and need not be routinely used.
dose of ovulation induction to be done.
Overall ,the clinician needs to carefully choose the
patients for IUI depending upon the age,indication,duration of infertility and
plan the stimulation accordingly.
After a maximum of three to four unsuccessful
cycles,case should be reviewed and move towards IVF is a reasonable approach.
So IUI remains the first line simple treatment for
childless couples,there is no need to panic.