Intrauterine Insemination - FAQs
Intrauterine Insemination (IUI)
A Multidimensional Approach to Infertility Management
A. The female reproductive system involves the uterus, ovaries, fallopian tubes, cervix and vagina. The female hormones, oestrogen and progesteron produced by the ovaries, rise and fall during the month and cause menstrual cycle.
In the first half of the menstrual cycle after the menstrual period, the oestrogen produced by the ovaries repairs the lining of the uterus. At the same time, an egg (ovum) in one of the ovaries matures. At about day 14 of a typical 28-day cycle, the egg is released from the ovary. This is called ovulation. This egg enters the fallopian tube.
In the second half of the menstrual cycle, the egg begins to travel through the fallopian tube towards the uterus. Progesterone levels rise and thicken the uterine lining to prepare for pregnancy. If a woman has had a sexual intercourse at around the time the egg is released, the sperm travels from the vagina to the fallopian tube where it fuses with the egg; this is called fertilization.
The male & female gametes (cells involved in sexual reproduction) fuse, multiply and after approximately 6 days of fertilization, these form a cluster of cells which gets attached in the uterus; that's when the woman is said to be pregnant. There is continuous release of progesterone which helps maintain pregnancy, thus giving a temporary break to the monthly periods.
A. Infertility is not being able to get pregnant after having regular sexual intercourse for at least 1 year without using any kind of birth control (contraception).
A. IUI is one of the procedures used to treat infertility. In this process, washed sperms from the male partner (or from a sperm donor when the male partner produces no sperms) are deposited in a woman's uterus around the time of ovulation, through a fine catheter (tube) inserted through the cervix (the opening of the uterus) into the uterus to deposit a sperm sample directly into the uterus. This is generally done in case there is no pregnancy after a natural intercourse or the sperm count in male partner is low (oligospermia).
A. The woman usually is given medications to stimulate development of multiple eggs (incase the infertility is due to no ovulation).
A semen* specimen is produced by masturbation after 2-5 days of abstinence (not having sexual intercourse).
During IUI, it is not possible to inject semen directly into the uterus because certain chemicals in the fluid can cause painful uterine spasms. Therefore, the semen is "washed" in the laboratory (process called sperm washing), and separated from dead sperms and other cells in the seminal fluid. This process takes about two hours. After preparation, the sperm concentrate is placed through the cervix into the uterus by using a thin, flexible catheter, which takes around 5-10 minutes. After the procedure, the patient can resume usual activities.
(*Semen, or seminal fluid, is a type of fluid containing sperms and several other components like enzymes, fructose, etc. that promotes the survival of sperms and provides a medium through which they can move.)
A. Any insemination should be carefully timed to occur at or a little before the time of ovulation (within 6 hours). Eggs are fertilizable for only about 12-24 hours (maximum) after ovulation. Therefore, lUls must be timed so that the sperms are present when the egg is released.
A. The doctor may suggest few tests before starting IUI treatment. The women may have to undergo tests to see that at least one fallopian tube is open (so that the sperm can enter the fallopian tube to fertilize the egg and the fertilized egg can come out in the uterus), tests to check the levels of hormones like follicle-stimulating hormone (FSH), luteinizing hormone (LH), oestrogen and progesterone, regardless of age.
Every male partner providing a semen specimen for IUI preparation must be tested for infectious diseases. If a woman is using donor sperm from a sperm bank, infectious disease testing must be performed prior to initiating donor sperm inseminations.
A. IUI success rates vary considerably and depend on many factors like:
- Age of the woman
- Use of any type of ovarian stimulation (drugs are given to stimulate ovulation)
- Duration of infertility
- Cause of infertility
- Number and quality of motile sperms (the ability of the sperm to move)
A. Most women consider IUI to be fairly painless as the catheter usually doesn't cause much of a discomfort. There can be some cramping afterward, but it is often ovulation-related rather than from the IUI.
A. Usually one can have intercourse anytime after an IUI. But if there was any kind of bleeding or complication during the IUI, some doctors may suggest waiting for 2 days before having an intercourse.
A. It doesn't usually happen, but it isn't uncommon; especially if there was a problem while carrying out the procedure. Some women also have light bleeding with ovulation.
A. Most pregnancies resulting from insemination with the male partner's sperm occur in the first 3 attempts. The chances for success per month decreases after about 3 attempts and drop further after about 4-5 unsuccessful attempts. Therefore, IUI treatment is usually recommended for a maximum of about 3 or 4 tries.
If the reason for infertility is lack of ovulation, it may be reasonable to try more IUI cycles.
A. IUI can help in cases where the man has low sperm count, or poor motility where the sperms are unable to reach the egg.
Because sperm is placed directly inside the woman's uterus, IUI can also help couples who are unable to have intercourse because of disability, injury, or difficulties such as premature ejaculation (where a man ejaculates early). It is also recommended for women with mild endometriosis (tissue that looks and acts like the lining of the uterus grows outside of the uterus in other areas like ovaries, bladder, etc.), and is often used as the first line treatment for couples with "unexplained infertility".
A. The male partner may be uncomfortable to produce a sperm sample at the doctor's clinic (timing of the insemination is crucial).
For women, IUI can be uncomfortable if the insertion of the catheter becomes difficult and also because IUI can cause cramps similar to pain during period.
With stimulated cycles, there is a risk of developing ovarian hyperstimulation syndrome (OHSS) a condition in which the ovaries respond too well to the drugs used to induce ovulation causing them to rapidly swell up to several times their normal size and lead to complications.
It is important to seek medical help if there is hyperstimulation and may need to stay in hospital.
The other risks associated with IUI are multiple pregnancy (twins, triplets), infections or ectopic pregnancy.
A. Approximately 2 weeks after IUI, a pregnancy test would be advised by the doctor to confirm the pregnancy.
For more information, contact your doctor.