IUI Procedure, Success Rates & Complications

Just like the In-Vitro Fertilization (IVF), Intrauterine insemination (IUI) is also a commonly used fertility treatment method. IUI works by putting sperm cells directly into your uterus when you’re ovulating, helping the sperm get closer to your egg. This cuts down on the time and distance sperm has to travel, making it easier to fertilize your egg.

Indications

1. Anovulatory cycles

2. Mild male factor subfertility

3. Unexplained subfertility

Prerequisite

1. Decent AMH

2. Sperm count -at least 5 million

3. At least 1 patent fallopian tube ( Advisable to have IUI in the cycle in which their ovulation is happening from the side of the open tube)

4. Sexually transmitted diseases have been ruled out or treated

Principle of Action

By stimulating the ovary with Low dose Gonadotrophin, the idea is to get one or two good quality eggs for ovulation. By semen washing the more motile sperm is separated from the rest of the fluid and debris and is released as close to the Ovum as possible bypassing the cervical mucus which at times might be hostile to the sperm.

Success rate

1. With clomiphene citrate or Letrozole – 6 to 10 % per cycle

2. With Gonadotrophins -18 to 20 % per cycle

3. IVF -30 to 35 % per cycle

Before the IUI cycle

1. Blood work of both the partners -Hormonal profile, Pre conceptional tests ( within 3 months of treatment cycle)

2. Partners semen analysis ( after 3 days of abstinence-neither sex nor masturbation)

3. Tubal patency test – HSG,Laparoscopy,Hycosy,Sonosalpingogram

4. Procure medication from the clinic and understand the usage and protocol with possible side effects)

Procedure

Due to an increased success rate, I prefer to use Gonadotrophins for stimulation. The usual dose is 50 to 75 units of recombinant FSH for 5 days starting from day 2 of the periods. Serum estradiol and an Ultrasound scan is advised the same day to rule out any functional ovarian cyst from the previous cycle from day 6th of the stimulation follicle tracking by ultrasound scan is done at the clinic and decided if further FSH is needed or not. Once the dominant follicle reaches a size of 18 to 20 mm, HCG injection is administered. 36 to 48 hours after HCG injection Ovulation is expected and IUI is timed accordingly. One needs to sign a detailed consent form prior to the procedure.

The partner is supposed not to ejaculate semen 48 hours prior to the procedure. On the day of the procedure, the Husband is supposed to give semen samples by masturbation at the andrology lab which takes almost 45 minutes in processing it. Once processed, semen is loaded in an IUI syringe and semen is put inside the uterus of the lady. IUI isn’t a painful procedure, done without anesthesia and at worst can be called uncomfortable.

The lady would need to lie down for 30 minutes post-procedure and is advised a Progesterone supplement for 2 weeks. In case of a missed cycle serum Beta HCG is recommended to confirm pregnancy. A total of 3 to 6 IUI cycles are recommended. The next step after which is IVF. Very rarely incase of hyperstimulation where there is the possibility of multiple pregnancies, the IUI cycle can be converted to the IVF cycle.

Complications

1. Minimal chance of Hyperstimulation of Ovary

2. Multiple Pregnancy

3. The side effect of drugs

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