Intrauterine Insemination (IUI)

Intrauterine insemination, also called Artificial Insemination involves placing processed, high-quality fractions of sperm taken from the semen into the uterus of the female partner, around the time of ovulation. The procedure is used for people who need help with conceiving and those who have unexplained infertility.

It can either be done either in a natural cycle or following medications to ensure mature follicles containing eggs in the ovaries.

IUI would be suggested as a treatment if you are a relatively young couple with a diagnosis of mild male factor infertility, unexplained infertility, or PCOS. IUI is also a good treatment in cases where there may be a requirement to use a male donor semen sample for conditions such as irreversible azoospermia or for single parents wanting to conceive. IUI is also an effective treatment in patients with psychosexual disorders, erectile dysfunction, or have other conditions that hamper normal sexual intercourse. IUI is often provided as the first line of treatment as it is less expensive in comparison to IVF.

The success rate of IUI treatment varies based on the age and cause of infertility in the woman and can vary between patients. On average, the published live birth rate for IUI is about 5-15% per cycle in women below the age of 35 years. Repeated IUI cycles increase the chances of pregnancy. 90-95% of patients who would have success with IUIs usually succeed within 3-4 cycles. The success rates of IUI beyond 4 cycles are extremely low.

The use of the correct laboratory procedures to estimate sperm count and perform the semen wash is critical for the success of an IUI procedure.

The results for pregnancy for an IUI cycle are checked on the 14th day after the IUI procedure.

If we assume 100 women undergoing IUI with a success rate of 15%, 15/100 would turn pregnant at the end of the first cycle. The second cycle has a 15% chance in the 85 women that failed in the previous cycle, i.e. 12.75 (~13) pregnancies, Similarly the third cycle would result in success in 10.8 (~11) patients and the fourth 9.15 (~9) patients. At the end of 4 cycles, approximately 48 of the 100 patients would have achieved pregnancy by IUI. The success rates of IUI drop significantly in patients who do not conceive after 4 cycles. Up to 6 cycles of IUI are recommended in young patients (women before 35 years of age) before going on to more advanced treatments such as IVF.

IUI is a relatively non-invasive and painless treatment. IUI or intrauterine insemination is a type of infertility treatment that involves the placement of washed sperm into a woman's uterus to facilitate fertilization. The procedure is usually done with no anesthesia or sedation and is usually painless. Patients who are anxious can request mild sedation during the procedure. Many women undergoing the IUI treatment don't experience pain during the procedure, but post-procedure cramps may be experienced in some.

IUI cycles follow the natural ovulatory cycles in women. The procedure starts on the second day of the menstrual cycle with a scan to track the number of follicles growing in each ovary. Follicles contain cells that mature into eggs which form an embryo after fertilization. The doctor may prescribe tablets or injections to help promote the growth of one or more follicles and the release of the egg. The doctor may be able to track the release of the egg by an ultrasound scan or by blood tests. The intrauterine insemination procedure is done once the follicle has ruptured to release the egg into the fallopian tube.

The IUI procedure would require a semen sample to be provided by the male partner on the day of the procedure. The male partner would be advised to abstain from sexual intercourse 3-5 days before the procedure to ensure adequate volume and quality of the semen sample. The semen sample would be collected by masturbation and washed in the laboratory to obtain a clean suspension of sperms that are healthy and motile. This process helps to remove dead, immotile sperms and other cells that may affect the success rates.

The sperms are loaded into a sterile thin plastic tube known as an IUI catheter. The doctor would then request the female partner to lie down on a gynecology couch or an IUI bed. The sperms are injected through the vagina and cervix into the uterus. The procedure is painless but can be performed under sedation in anxious patients. The procedure would take about 15 to 20 minutes following which the doctor would ask you to rest for about 30 minutes.

The doctor would check levels of a hormone called beta-hCG, 14 days after the procedure to check for pregnancy in your urine or blood. If the woman has her periods within this time, it suggests a failure of the IUI cycle. The cycle may be repeated by your doctor to increase the chances of pregnancy.

If your doctor recommends IUI as a treatment, it's important to understand that each cycle from start to result can take one month. The treatment process usually starts on the second day of the menstrual cycle of the female partner. The doctor may prescribe hormonal injections or tablets for a period of 7-14 days. The doctor may also require you to come into the clinic to track the growth of follicles on a scan periodically. You would be advised a trigger injection when your follicles reach an appropriate size. The IUI procedure will be performed 36-40 hours after the trigger injection. The doctor may perform a scan on the day of the procedure to evaluate if the follicle has ruptured. The male partner would have to provide the semen sample on the day of the procedure. The male partner would be advised to abstain from sexual intercourse for 3-5 days before giving a sample.

There would be a wait of 14 days (often called the two-week wait) before one can evaluate if the treatment is successful or not. The success of the treatment is determined by performing a urine pregnancy test or a blood pregnancy test, 14 days after a procedure.

Success rates for intrauterine insemination (IUI) vary according to the cause of infertility and the number of IUI treatments you have. Generally, success rates range from 12-22% per IUI treatment, so you will need at least four to six treatments before you can really evaluate whether or not IUI is the best treatment for you. It is important to understand that the IUI treatment may take up to 6 cycles (1 month per cycle x six months) before a couple can see success.

Nearly 90% of women conceive by IUI within 6 attempts. It's important to remember that the success rates projected by a clinic may be different based on underlying problems. Failure to conceive within 6 attempts suggests the requirement for a more detailed assessment and more advanced procedures such as IVF.

IUI treatment is relatively non-invasive and safe. Although rare, the side effects of IUI treatment may include but not be limited to the following:

a. Mild cramps similar to period pains

b. Mild spotting post-procedure

c. Multiple pregnancies (twins, triplets)

d. Hyperstimulation resulting in large engorged ovaries, a bloated feeling, and risk of dehydration

e. Infection (very low risk)

f. Ectopic pregnancy (embryo implanting outside the uterus)

In case of an IUI failure, the most important thing is to be realistic about your chances of success. Failure of 1 or 2 cycles of IUI does not mean that there is a failure of fertility treatment. It is important to understand that there is a 12-22% chance of success per cycle and that up to 6 cycles may be required for a couple to really see success. The chances of success may also be impacted by the age of the couple, quality of sperm, underlying diagnosis amongst other factors.

Depression and anxiety are very common in these situations. But it's a good idea to get counseling and diagnosis from a doctor to see if it's anything else that could have been done. Often every cycle provides the doctor an understanding of how your body responds to medications and treatment and may help her or him to make changes to the treatment as per the need of your body.

The most important thing is not to lose hope and make the best out of the situation.

Depending on your cause of infertility, age and previous treatment availed a total of 3 to 6 IUI cycles have been found to be beneficial. Your doctor will discuss the options available at every stage and you could expedite the process if you so desire.

IUI treatments cost between Rs 10,000 and 25,000 per cycle in a city like Bangalore. There are two main parts of the cost involved, the cost of medications and the cost of the procedure. Medications usually cost between Rs. 500 to about 8,000 depending on the dose and type of medicines used. Tablets such as letrozole or clomiphene citrate are cheaper whereas gonadotropin injections may be more expensive. The procedure cost is usually about Rs. 4500 to 12,000 depending on the hospital or doctor that you are seeing.