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
readers.

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:

  1. Basic
    ultrasound for the wife
  2. Basic
    semen analysis
  3. Atleast
    one normal tube confirmed by HSG(Hysterosalphingogram)-tubal testing by
    inserting a dye inside the uterus and taking X rays.

Procedure:

  • The first visit is when the menses
    starts,a scan is done.
  • A
    tablet called Letrozole or Clomifene citrate is started for 5 days with or
    without combination of injections.
  • The
    next visit is for a scan on day 11 or day 12.
  • The
    scan will show 1 or 2 follicles 18 to 20mm in diameter.
  • There
    may be a need for 2 or 3 sittings for scans.
  • HCG
    shot is given and IUI is done 36 hrs to 38 hrs later.
  • Total
    motile sperm count should be 5 to 10 million.
  • Soft
    catheter is used for insemination into the uterus in the lying down position.
  • Bed
    rest for 10 to 15 mins post procedure is advisable.
  • Single
    well timed IUI will give good results.
  • Gentle
    atraumatic technique is important.
  • IUI
    should be performed as soon as possible just after processing and within 90
    minutes of collection to optimize the outcome
  • The
    couple is advised to have intercourse the next day as the egg lives for a
    little more than 24 hrs.
  • Progesterone
    hormonal tablets are given from the second day after IUI for 15 days.
  • A
    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?

  • Subnormal
    semen parameters
  • Sexual
    dysfunction:like impotence,anejaculation
  • HIV
    discordant couples
  • Ovulatory
    dysfunction/Anovulation
  • Previous
    cervical surgery or infections
  • Unexplained
    Infertility
  • Failure
    of atleast 3 naturally tried cycles.
  • Minimal
    endometriosis
  • Less
    than 5 years of infertility

When IUI should not be done?

  • Bilateral
    tubal block
  • Less
    than 1 million sperm count in postwash semen
  • Severe
    Pelvic Infection

Critical factors for success are:

  1. Patient
    Selection
  2. Ovulation
    Induction
  3. Timing
    the Insemination accurately
  4. Post
    wash total motile sperms

Pros and Cons of IUI?

Pros Cons
First line treatment Limited indications
Simple and easy Low success rate
Economical Multiple pregnancy
Less invasive Ovarian hyperstimulation
Less psychological burden  
Good compliance  
Less complications  
Minimal infrastructure  

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
naturally.

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
to IVF.

Certain Facts about IUI:

  • 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.
  • IUI
    should not be done if there are more than 3 big follicles.
  • Ultrasound
    guided IUI offers no benefit and need not be routinely used.
  • Lesser
    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.