Intrauterine insemination (IUI)

Overview
• Intra-Uterine Insemination (also known as artificial
insemination)
• is the process of preparing and delivering a washed and
highly concentrated amount of active motile sperm directly
through the cervix into the uterus around the time the ovary
releases one or more eggs to be fertilized.
• IUI is sometimes done in natural cycle,” which means no
medications are given.
• A woman ovulates naturally and has the sperm placed
around the time of ovulation.
• IUI can also be combined with ovarian stimulation
Medications such as clomiphene citrate (Clomid),
hCG (human Chorionic Gonadotropin), and FSH
(follicle stimulating hormone) may be used to prompt
the ovaries to mature and release an egg or multiple
eggs.
• Ovulation with more than one egg usually increases
chance of multiple pregnancy.
• After the initial consultation and counselling,if the
IUI is choosen best for fertility, doctor may advise for
a typical timeline which may include the following:
several visits may be needed while patient is on period
for blood work, ultrasounds, and medication instructions.

If medications are prescribed, patient usually needs start

taking them while on period.

About a week after starting the medication, another

ultrasound and possibly blood work may be done .

Depending on test results, doctor will determine when

ovulation takes place and male partner will return to the
clinic. This is typically 10 to 16 days after starting the
medications.
• Prior to initiating IUI treatment, women must have at
least one documented open fallopian tube as
demonstrated by hystero - salpingogram (the tubal
dye study).
• There are several techniques available for preparing
the sperm for IUI.
• All of the techniques involve separating sperm from
seminal fluid.
• It is not possible to inject semen directly into the
uterus because of chemicals in the fluid that can
cause extremely painful uterine contractions.
• Motile sperm are separated from dead sperm and
other cells through the use of viscous solution.
• The male partner brings or produce his specimen for
laboratory several hours prior to the IUI procedure.
• The hoped-for outcome of intrauterine insemination
is for the sperm to swim into the fallopian tube and
fertilize a waiting egg, resulting in pregnancy.
• Depending on the reasons for infertility, IUI can be
coordinated with normal cycle or with fertility
medications.
Why it's done
Intrauterine insemination is used most often in couples
who have:
• Donor sperm. For women who need to use donor
sperm to get pregnant, IUI is most commonly used to
achieve pregnancy. Frozen donor sperm specimens
are obtained from certified labs and thawed before
the IUI procedure.
• Unexplained infertility. IUI is often performed as a
first treatment for unexplained infertility along with
ovulation-inducing medications.
• Endometriosis-related infertility. For infertility
related to endometriosis, using medications to obtain
a good-quality egg along with performing IUI is often
the first treatment approach.
Mild male factor infertility (subfertility).
• If Male partner's semen analysis shows below-
average sperm concentration, weak movement
(motility) of sperm, or abnormalities in sperm size
and shape (morphology) IUI can overcome some of
these problems because preparing sperm for the
procedure helps separate highly motile, normal
sperm from those of lower quality.
Cervical factor infertility. 
• Mucus produced by the cervix around the time of
ovulation provides an ideal environment for sperm
to travel from the vagina to the fallopian tubes. But,
if cervical mucus is too thick, it may impede the
sperm's journey.
• The cervix itself may also prevent sperm from
reaching the egg. Scarring, such as that caused by a
biopsy or other procedures, can cause the cervix to
thicken. 
• In this condition through IUI ,sperm can be deposited
directly into the uterus and increasing the number of
sperm available to meet the awaiting egg.
Ovulatory factor infertility.
 IUI may also be performed for women who have
infertility caused by problems with ovulation, including
an absence of ovulation or a reduced number of eggs.

Semen allergy. Rarely, an allergy to proteins in semen

can cause infertility. Ejaculation into the vagina causes
redness, burning and swelling where the semen contacts
the skin. A condom can protect from the symptoms, but
it also prevents pregnancy. If the sensitivity is
severe, IUI can be effective, since many of the proteins in
semen are removed before the sperm is inserted.
IUI can be performed using a male partner’s sperm or
donor sperm.
IUI is also used in these scenarios:
• mild endometriosis
• issues with ejaculation or erection
• same-sex couples wishing to conceive
• a single woman wishing to conceive
• a couple wanting to avoid passing on a genetic
defect from the male partner to the child(donor
sperm)
IUI isn’t effective in the following conditions;
• women with moderate to severe endometriosis.
• women who have had both fallopian
tubes removed or have both fallopian
tubes blocked.
• women who have had multiple pelvic infections.
• men who produce no sperm (unless the couple
wishes to use donor sperm).
success rate?
A number of factors affect the outcome, including:
• age
• underlying infertility diagnosis
• whether fertility drugs are used
• other underlying fertility concerns
Pregnancy rates following IUI are varied based on the
reasons for needing fertility treatment.
Success rates for IUI tend to decrease in women over
the age of 40, and in women who have not gotten
pregnant after three cycles of IUI.
Patient should discuss her predicted success rate with
the fertility specialist to see if this a good option for
her.
Risks
the risk of serious complications is low.
other Risks include:
• Infection; There's a slight risk of developing an
infection as a result of the procedure.
• Spotting ;small amount of vaginal bleeding due to
placing catheter inside uterus. This doesn‘t effect
on the chance of pregnancy.
• Multiple pregnancy. Due to coordinated with
ovulation-inducing medications, the risk of a
multiple pregnancy increases significantly. A
multiple pregnancy has higher risks than a single
pregnancy does, including early labor and low
birth weight.
Preparing the semen sample. 
• Male partner provides a semen sample at the OPD, or
a vial of frozen donor sperm can be thawed and
prepared.
• the sample will be washed in a way that separates
the highly active, normal sperm from lower quality
sperm and other elements.
• The likelihood of achieving pregnancy increases by
using a small, highly concentrated sample of healthy
sperm.
Monitoring for ovulation. 
• Because the timing of IUI is crucial, monitoring for
signs of impending ovulation is critical.
• To do this, patient might use an at-home urine
ovulation predictor kit that detects when the body
produces a surge or release of luteinizing hormone
(LH). Or, an imaging method that lets your doctor
visualize your ovaries and egg growth (transvaginal
ultrasound) can be done.
• You also may be given an injection of human
chorionic gonadotropin (HCG) or medications to
make you ovulate one or more eggs at the right time.
Determining optimal timing.
 Most IUIs are done a day or two after detecting
ovulation. The doctor will have a plan spelled out for
the timing of the procedure and what to expect.
What you can expect
The visit for intrauterine insemination takes about 15
to 20 minutes and is usually done in a doctor's clinic.
The IUI procedure itself takes just a minute or two and
requires no medications or pain relievers. doctor or a
specially trained nurse performs the procedure.
During the procedure
While lying on an exam table put legs into stirrups.
Doctor inserts a speculum into the vagina — similar to
during a Pap test.
During the procedure, the doctor or nurse:
Attaches a vial containing a sample of healthy sperm to
the end of a long, thin, flexible tube (catheter).
Inserts the catheter into the vagina, through the
cervical opening and into the uterus.
Pushes the sperm sample through the tube into the
uterus.
Removes the catheter, followed by the speculum.
After the procedure
After insemination, you lie on your back for a brief
period. Once the procedure is over, you can get dressed
and go about your usual daily activities. You may have
some light spotting for a day or two after the procedure.
Results
Wait two weeks before taking an at-home pregnancy
test. Testing too soon could produce a result that is:
False-negative. If pregnancy hormones aren't yet at
measurable levels, the test result may be negative when,
in fact, you really are pregnant.
False-positive. If you're using ovulation-inducing
medication such as HCG, the medication that's still
circulating in your body could indicate a pregnancy when
you really aren't pregnant.
\ doctor may instruct to return about two weeks after
your home kit results for a blood test, which is more
sensitive in detecting pregnancy hormones after
fertilization.
If you don't become pregnant, you might try IUI again
before moving on to other fertility treatments. Often,
the same therapy is used for three to six months to
maximize chances of pregnancy