In intrauterine insemination (IUI) washed and prepared sperms are introduced into the woman’s uterus, timed with ovulation, with the aim of getting the sperms nearer to the ovum .There are two types of IUI:
IUI-H – IUI with Husband’s semen.
IUI-D –IUI with donor semen.Drugs commonly used are clomiphene citrate, injectable gonadotropins starting from day 3-5 of the menstrual cycle. Concurrently serial transvaginal sonography is done to monitor follicular development from day 2-3 of the period. When the leading follicula becomes 18-20 mm in size, HCG (HUMAN CHORIONIC GONDOTROPIN) trigger is given. IUI is planned 18-40 hours after the trigger. The husband is asked to collect a semen sample, preferably in the semen collection room in the vicinity of IUI lab, or alternatively, he can get the sample in a clean sterile, non-toxic container from home. The sample should reach the best quality and most motile sperms are harvested by one of the different semen preparation techniques. The washed sperms are deposited in the uterine cavity by a flexible.
Success rate of IUI– varies from 25-30 %.depending on age of female partner entered of male factor, cause of infexibility, media equipment and exposite of center doing it. We are doing it for last 15 years. IVI sample preparation done in house by highly trained embryologist under suprevision of Dr. Neelam Mishra best medias of world like medical used in very well maintained andrology lab.
Indications for IUI
1) Impotence/ ejaculatory problem like Hypospadias, Spinal cord injury, Diabetes mellitus, Drugs (sedatives, anti-depressants, medications for B.P and acidity.
2) Retrograde ejaculation – Reflux of semen backwards into bladder-
After some surgeries – TURP (prostate
3) Sub-normal semen parameters :
Oligozoospermia (count less)
Asthenozoospermia (motility less)
Teratozoospermia ( Abnormal make of sperm)
Hypospermia (less semen amount)
Highly viscous semen
4) Psychological reasons.
5) HIV or other sexually transmitted disease in male partner
Female factors :
1) Problem of ovum (egg formation)- 30-40% female factor.
2) Cervical factor – Stenosis, malformation, cervicitis, infection, previous surgeries
3) Endometriosis – Mild and moderate grade
Common factors : (Both male and female)
1) Immunological – Antisperm antibodies
2) Unexplained infertility – When a couple fails to conceive despite there all tests being normal.
Principles of IUI & IVF – (How does it help?)
1) More number of gametes (eggs) by ovulation induction.
2) Improving egg and sperm quality by using medicines and enriching media.
3) Bringing the gametes (eggs and sperm) together by IUI or IVF/ICSI.
Indications for donor sperm IUI (Donor IUI)
1) Severe male factor infertility – Azoospermia (no sperm), severe oligospermia (very few sperms), poor motility (movement of sperms)
2) Couples in which one or both the partners have a heritable disease (that will be transmitted to the baby and next generations)
3) Couple in whom husband has communicable diseases (HIV, Hepatitis B, Hepatitis C etc)
4) Female partner is RH negative and severely RH isoimmunized, and the male partner is RH positive.
5) Persistent IVF / ICSI failures.
6) Patient unable to afford ICSI.
Indications for Insemination with husband’s frozen semen
1) Absentee husband
2) Antinepolastic treatment
3) Drug therapy
Evaluation of female partner :
1) Routine investigations :
BMI (Body Mass Index)
WHR (Waist to Hip Ratio)
2) Hormonal investigations :
D2 – D3 – FSH, LH, E2
T3, T4 , TSH
3) Test for ovulation :
a) Serial vaginal ultrasound (Follicle monitoring)
b) Serum Progesterone on day 21 of cycle.
c) Urinary LH surge testing
d) Basal body temperature
4) Test for tubal assessment :
a) Hysteroslapingography (HSG)
b) Sonosalpingography (SSG)
c) Diagnostic laparoscopy & hysteroscopy
Evaluation of male partner:
1) Detailed history and examination
2) Built, hair distribution, Gynecomastia, examination of testis, vas, epididymis.
3) Semen analysis and culture
4) Routine blood analysis and hormonal analysis
5) Ultrasound of testis.
In whom IUI can be done?
1) Female partner age less than 40 yrs with spontaneous induced ovulation.
2) At least one fallopian tube open.
3) Pre wash sperm count more than 10 million/ml and motility more than 40%
4) Easy access to cervical canal.
Semen can be preserved for future use.
1) In patients with cancer before surgery, radiotherapy or chemotherapy.
2) For people who stay out of city for long durations.
3) For person who work in place with risk of radiation hazard.
4) For storage of sperm after PESA & TESA or electroejaculation.
5) For anticipated performance failures on day of insemination.
What Does IUI Involves?
Hermonal tablets and injection develop 2-3mature eggs during that menstrual cycle. Ultrasound monitoring and if required blood tests are carried out for Day2 till day of egg maturetion so that we can that how you. IUI cycles begin with you taking hormonal injections to help your body develop a relatively high number of mature eggs during your menstrual cycle. Monitoring scans and blood tests are carried out throughout your cycle so we can track how your body is responding.
When your body is ready, you may be given ‘trigger’ medication that causes you to be ready to ovulate. Sperm will be ‘washed’ to remove any excess material and then inserted into your uterus and left to fertilise. Two weeks later you will have a pregnancy test.
Around two hours before your partner is ready to have her fertilisation procedure you will visit our dedicated men’s room to produce a sperm sample that will be used to fertilise her eggs. Once the sample is ready it will be taken into a laboratory and ‘washed’ to remove excess materials, and then put by a tuin into your partners uterus and left to fertilise.