Intra Uterine Insemination

IUI or intra uterine insemination is a procedure where the processed semen sample with actively motile sperms is instilled in the uterine cavity of the female partner.

It is a very simple and basic procedure.

We install the sperms in a more motile form inside the cavity bypassing the cervix or the mouth of the uterus. The rest of it is still left up to chance as in, the sperms have to meet the egg, fertilise the egg and the fertilised embryo should reach and implant in the uterus, all on its own!

Procedure

• The couple starts with ovulation induction drugs after meeting the doctor.
• Follicular monitoring is done by ultrasound starting day 10 or 11 of the cycle.
• Once the dominant follicle reaches at least 16 mm in size, we induce ovulation by an injection of human chorionic gonadotrophin.
• Single or in some cases double insemination is then planned from the time of this injection accordingly.
• At the stated time, on the day of the IUI, the male partner should accompany his wife. He is asked to produce a semen sample by masturbation.
• The semen sample is then processed by the technician in the IUI lab by different methods according to the quality of the sample. This is expected to take roughly an hours’ time.
• After processing, a small quantity of the final sample, is taken in an IUI catheter which is then instilled in the wife.
• The actual procedure of insemination takes only five minutes or less in most cases and it is not painful.
• After the insemination the wife is asked to lie down for a period of 20 min following which she can get up and go home.
• Supportive medicines if any are then prescribed and the lady is then asked to report after two weeks with a pregnancy test report.

IUI(H) OR IUI(D)

IUI(H) is where the husband’s semen sample is used for insemination.as a pre requisite we would have taken a complete personal and family history and done basic blood investigations including serology.

IUI(D) is where due to very poor quality of semen(oligoasthenospermia)or absent sperms(azoospermia) in the husband, the couple after counselling for donor sample insemination.

The actual procedure of choice in such situations is ICSI and counselling is given about the same. But in cases where due to financial constraints, the couple are not able to afford ICSI, they may choose for IUI-D. the procedure remains the same but in lieu of using the husband sample, we inseminate samples taken from reputed semen banks. the signed informed consent of both husband and wife is absolutely essential for this procedure.

We take into consideration the blood groups of both husband and wife as well as skin colour and eye colour before contacting the semen bank for an appropriate sample.

SINGLE OR DOUBLE INSEMINATION?

As there is no proven benefit with doing double inseminations, we as a routine start with single inseminations timed 36 hrs after the hcg injection.

in some cases, where the sperm counts are low or where there have prior failed cycles, we do double inseminations times 24 to 28 hrs and 36 to 40 hrs post hcg injection.

PRE REQUISITES

Patent tubes

An adequate semen sample of at least 5 million/mm minimum

Documented ovulation

Age of the woman less than 40 years preferably

HOW MANY ATTEMPTS?

The textbook teaching and evidence says that the maximum number of pregnancies occur in the first three attempts and if there is no success to convert to IVF.

but, in reality we determine the number of attempts taking into consideration the age of the couple, the period of married life and co morbid factors if any. This is a decision taken after careful discussion with the couple involving them in their plan of care.

consideration about their financial status has also to be taken into account in our country.

beyond three cycles we generally advise COH or controlled hyper stimulation with the use of gonadotrophins.

usually we advise between 3 to 6 cycles totally though we have gone beyond this if the couple cannot afford IVF.

SUCCESS RATES

In a couple with an average period of married life, wife less than 35 years, semen parameters normal, the average success rate is about 10 to 15 % per month.

POST IUI INSTRUCTIONS

We advise them to continue with their regular routine and normal dietary habits.

There is no need for extra rest or definitely no need for bed rest in any manner as it does not improve the success rates.

Couples can continue to have sexual intercourse if they so desire.

Any medicines if prescribed are to be taken orally or vaginally as advised.

We may ask the wife to take a beta hcg blood test about 12 to 15 days’ post IUI to determine pregnancy.

If the couple are from out of Chennai, we ask the lady to come back if she misses her period by more than a week following the course of medicine.

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