Intrauterine insemination (IUI), a type of artificial insemination, is an infertility treatment technique.
During natural conception, sperm has to pass from the vagina via the cervix, through the uterus, and up to the fallopian tubes. With IUI, sperm are "washed" and concentrated and are inserted directly into the uterus, bringing them closer to the egg.
The hoped-for outcome of intrauterine insemination is for the sperm to swim into the fallopian tube and fertilize a waiting egg, resulting in a natural pregnancy. IUI can be coordinated with the usual cycle or with fertility drugs, depending on the reasons for infertility. In some couples who have had trouble getting pregnant, this phase will increase the chance of pregnancy.
Candidates suitable for IUI process
Many who often turn to IUI for fertility issues are often women with mild to severe endometriosis, women with cervical mucus problems, women with allergies to semen, or sometimes women pregnant with donor sperm. In certain cases, IUI can be useful, but in all kinds of infertility situations, it is not ideal. It should not be done more than 5-6 times and there is no additional advantage in cases of infertility caused by females. In certain cases, IVF can be directly prescribed by infertility physicians.
In addition, patients with the highest chances of success with IUI typically have:
- Hormone levels within a healthy range
- Enough quality eggs in their ovaries
- Fallopian tubes that are not blocked and are in good condition
- A male partner with an appropriate sperm counts or donor sperm
- Fair expectations for the treatment result
If patients have any of the following considerations, they might not be a candidate for IUI:
- Severe endometriosis
- Infertility of severe male factor
- A history of pelvic adhesions
- Tubal disease
- A low reserve for the ovaries
IUI process step by step
Undergoing an intrauterine insemination cycle involves taking medicine to stimulate the ovaries to produce eggs, then directly injecting extracted sperm into the uterus at the time of ovulation using a simple technique. We'd like to take you through the whole process, so you know what to expect.
- Stimulate Egg Growth: To stimulate the growth and maturation of her eggs, the woman starts taking oral or injectable medicine. The injections are only under the skin (subcutaneous) and are recommended for a fatty region of the body, such as the stomach or the top of the thigh. Oral medication is taken for 5 days and injectable medication is usually taken for 8-12 days, depending on the reaction of the ovaries.
- Ultrasound & Blood Monitoring: To monitor the ovaries and egg production, brief ultrasound appointments are required every 2-3 days while on injectable medication. In order to determine hormone levels related to egg growth and ovarian function, blood tests are also performed. It is ensured everything is going safely through this testing and tracking.
- Ovulation Induced: A patient receives a "trigger shot" once a "mature" egg is present, which triggers ovulation within about 36 hours. The shot is given in the clinic or self-administered at home by a nurse. Processed sperm sample: A sperm sample is given by the male partner or a donor sperm sample is thawed, and processed by the laboratory. The sperm sample is "washed" during preparation to remove debris, immobile sperm and semen substances that could cause extreme cramping and the sperm cells are highly concentrated in a small amount.
- Insemination Procedure: A woman lies on an examination table, much like a routine pelvic examination. The sperm sample is inserted through a small, long, flexible catheter into the uterus. The whole procedure is basically painless and takes seconds to finish. Getting up shortly after the operation would not have an effect on pregnancy chances. On certain occasions, insemination will be recommended two days in a row, but in most cases, a single well-timed insemination is all that is needed in each cycle.
- Follow-Up: Follow-Up: Progesterone levels are measured after a week of ovulation. In order to better prepare the uterine lining for pregnancy, additional hormone support (such as progesterone) may be recommended for certain patients. For women with repeated miscarriages, progesterone support is used.
Additional Testing: Follow-up blood testing, about two weeks after insemination, decides whether pregnancy has occurred.
Risk Associated with IUI treatment
Below are some potential complications that could occur after receiving IUI treatment or other fertility treatments.
- Risks from Ovarian Hyper-Stimulation: This risk is related to the fertility drugs administered during IUI. Clomid or Clomiphene Citrate is a popular ovulation-inducing medicine administered to 'hyper-stimulate' the ovaries by doctors. This effectively allows more than twenty follicles to grow in the ovaries at one go. As a consequence, the body's hormone levels are built up, leading to ovary enlargement that leads to extreme abdominal pain due to swelling. Breathing problems, nausea and vomiting are the other accompanying symptoms. Hyper-stimulation of the ovaries can be lethal in acute situations. This may also happen with HCG or Gonadotropin Treatment.
- Risk of Infection: During the IUI process, there could be a small risk of infection as it involves inserting a thin tube through the cervix to place the sperm into the uterine cavity. During the insertion, some women can feel some pain or cramping. However, the greater risk of damage to the cervix causing acute pain, spotting or bleeding during the operation may possibly be during insertion. Therefore, at the conclusion of the operation, doctors often suggest resting for a while to minimize the chances of any potential pain. Intrauterine insemination is a straightforward procedure and is known as one of the least invasive techniques. The side effects associated with the procedure are very low. Most of the side effects of treatment with IUI typically subside over time or are removed after fertility treatments are stopped.
- Multiple pregnancy: IUI itself is not associated with an increased risk of multiple pregnancies (twins, triplets, or more). But the risk of multiple pregnancies increases dramatically when coordinated with ovulation-inducing drugs. Multiple births, including early labour and low birth weight, have higher risks than a single pregnancy.
- Other IUI Side Effects: The other side effects that may arise due to medication like Clomid are:
- Abdominal discomfort and pain
- Hot flushes
- Digestive problems
- Pain in the breasts
- Menstrual irregularities
The other significant risks include the effect of the drug on the consistency of cervical mucus, which is hostile to sperm and contributes to IUI complications. It appears to thicken and dry up, thus preventing the sperm's entry into the uterus. In order to cure these mucus issues, doctors normally recommend estrogen supplements.
Success after IUI
The beginning of the journey of fertility treatment is sometimes intrauterine insemination (IUI). Creating a safe pregnancy environment is the first step to good fertility. Below are 4 tips after IUI to maximize pregnancy success.
- Avoid strenuous exercise: Right after the IUI treatment, the patient will normally return to daily activities. There is no need for bedrest, but tasks should be limited to a lower intensity. Premature contractions can be caused by vigorous exercise, preventing implantation. Exercises with low effect, such as cycling, yoga, and light aerobics, are good. It is worth avoiding high aerobic exercises like jogging.
- Take prenatal vitamins: To help a healthy pregnancy, vitamins ensure that the mother receives the requisite nutrients. There are also higher levels of folic acid and iron in prenatal vitamins than in daily multivitamins. For spinal development in infants, folic acid is particularly crucial. When beginning family planning, women should begin taking prenatal vitamins. Even if the mother is not pregnant yet, the prenatal vitamins will prepare the body.
- Eat well: Eating to encourage general health will eliminate the possible roadblock to fertility. For survival and growth, the growing baby will be fully dependent on the mother. The wellbeing of the mother will be that of the infant. Improving as good an internal environment as possible can improve fertility. Wellbeing can be promoted by a diet rich in leafy greens, lean proteins, and healthy fats.
- Have a backup plan: The path towards fertility is always long and stressful. Before having a healthy pregnancy, several couples experience several attempts. The fertility plan may need to be revalued if a couple is unable to become pregnant after 3 IUI attempts. With each subsequent cycle, while chances improve, every attempt after the 3rd has a drastically reduced success rate. In vitro fertilization (IVF) might be an option if IUI does not work.
IUI Success rates
IUI's performance depends on many considerations. If a couple has the IUI procedure performed every month, depending on factors such as female age, the cause of infertility, precautions taken in sperm washing, medication used for ovarian stimulation, timing of the IUI procedure, etc., success rates can reach as high as 20 percent per cycle. Although IUI is a less invasive and less costly choice, IUI treatment success rates are much lower than IVF treatment success rates.