Intra Uterine Insemination (IUI) treatments by ARC Fertility Hospital Chennai, India is associated with good success rates even in failed IUI by proper selection of cases and good IUI preparation and effective IUI process
What is IUI ?
It is Intra Uterine Insemination
For whom it is recommended ?
When a couple failed to conceive naturally or following follicular tracking and timed coitus.
Indication for IUI
A male partner with low sperm count
A female partner with diminishing / ovarian reserve
A female partner who has irregular, anovulatory cycles & failed to conceive.
A female partner should report on D2 / D3 of her cycle. A scan is done to assess her antral follicle and absence of cysts. Then she is advised pills (clomiphene citrate) Normally a women has 7 – 10 follicle (follicle is a fluid filled with egg inside). On both sides 15 – 20 follicles are seen in a healthy fertile women, of which only one follicle grows and a women becomes pregnant naturally with only one gestation. Rarely we come across twins or more in natural pregnancy. In IUI when a couple is unable to conceive naturally to boost the fertility, ovulation induction (OI) are given to grow more follicles. Sometimes clomiphene citrate in higher dose in some women affects the endometrial receptivity and pregnancy.
Hence it is recommended to get more follicles grow consistently, we administer FSH/HMG from day 3 or day 5 onwards for 5-7 days. The purpose of OI drugs is to facilitate a women to recruit more follicles. The female partner is advised to come for a follicular tracking scan D10 or D11 onwards. The scan will be done on alternate day to see the growth of follicle. When the lead dominant follicle reaches 18 – 22mm, we give HCG injection, for the follicle to undergo final maturation and rupture. The rupture of follicles can be confirmed by a scan. During this step. We ask the husband to give the semen. The semen is processed in andrology lab to remove the dead / immotile sperms, pus cells and isolate only active motile normal sperms. Once the sperms are processed it is injected into the female partner via a small catheter introduced into the vagina upto uterus. The semen is introduced very gently to avoid contraction of uterus and avoid expell the semen into the vagina subsequently. Sometime USG guidance is used for semen placement.
Why the semen is processed and raw semen is not placed inside the uterus ?
During intercourse the semen is ejaculated in vagina. There is a narrow passage called cervix is present beyond the vagina. This passage allows access only to normal, healthy sperms into the uterus, thereby prevents the uterus & tubes from infected.
The unwanted semen, gets flushed out of vagina during the ambulation (movement) of female partner. Whereas in IUI, we inject the semen into the uterus. Hence we process the semen and inject disease free, healthy, active, motile sperm inside. A processed sperm is is viable inside the uterus from 24 – 72 hours. In some female partners after HCG injection, true ovulation (rupture of follicles) happens from minimum 36 hrs to maximum 60 – 72 hours. Since the time range is more, we do double IUI insemination in same cycle, for exposure of more sperms to improve fertilization and improve the success rates.
After semen injection (IUI), the female partner is advised to maintain the lying posture 5 minutes. Then she can travel (2/3/4 wheeler, train / bus) all means without any concerns.
Post IUI follow up process
No physical activity / restriction is needed. Bed rest not required / working women can resume to job after IUI.
Women will be given medications for 2 weeks. which has to be taken without fail.
Normal diet can be taken after IUI
Couple can indulge in sexual intercourse on their own interest after IUI.
If the female partner has not received cycle after 2 weeks of IUI report to us and plan for serum pregnancy test.
If positive take the Dr advise periodically. If negative, repeat test after 5 days if cycle has not come. If the female partner gets her menses, no need to worry/. Report on D2 D3 to start the next IUI cycle. A couple is advised to undergo 3 cycles of IUI continuously. The reason behind this the OI drugs shows enhanced effect in subsequent cycles and higher success rates in same couple. Hence dont get upset, if you fail conceive in 1st or 2nd cycle of IUI. If you fail to conceive 3 cycles of IUI, and all the process went to the expectation a term “fertilization failure” may be considered and the couple based on age / duration of infertility / medical problems is advised one more round of IUI or progress to IVF / ICSI.
A couple conceived naturally with scan monitoring / IUI / assisted normal conception is advised medications immediately after pregnancy and follow up.
Ensure the gestational sac / viable pregnancy is seen 5 weeks of pregnancy and the presence of sac in the uterus to exclude ectopic pregnancy.
Check for foetal heart from 8th week onwards.
A stitch in case of thin cervix / multiple pregnancy is advised for some pregnant women.
Subsequent process as advised by the O & G Specialist, customised to you.
Fertility drugs often referred , and used to stimulate the process of the follicles in the ovaries , which results in the production of multiple eggs in one cycle. Medications also control the time that you release the eggs, or ovulate, the certain procedures that can be scheduled,like sexual intercourse, intrauterine insemination’s and in-virto fertilization that can help achieve pregnancy.
In the course of ovulation induction there are certain risks involved, considering medications that include an increase the change of high order multiple births, and also development of ovarian cysts. There is a very rare side effect which can occur which is ovarian hyper-stimulation syndrome (OHSS), the symptoms are difficulty in breathing, increase in weight, severe pain in the pelvis, abdomen & chest, nausea vomiting & bloating.
Super ovulation is the most aggressive level of ovulation induction. This can be treated by the combination of medications to stimulate the production of multiple eggs.
Patients who undergo supervoulation, must take extra care and closely monitored by blood tests and ultrasounds. The doctor needs to ensure that the patient does not hyper-stimulate and the right dosage is administered, so that only a few follicles develop. This is critical as the pregnancy level needs to be controlled . When the super ovulationn treatment is over a mild dose of trigger is administered to stimulate the ovulation. After around 24-36 hours of trigger isadministered, ovulation will occur. The doctor advises the patient to either have sexual intercourse or come to the clinic for an intrauterine insemination. The success rate per super ovulation , depending on the cause of infertility, depending on the age of the women. type of medications used for stimulation and the sperm concentration during IUI insemination