What is IUI and how can it help male factor infertility?

What is IUI?

Intrauterine insemination (IUI) is process where sperm are artificially placed in the uterus with the help of a catheter. This procedure helps to ensure that more sperm are available and able to access a woman’s egg, thereby aiding fertilisation and conception. IUI is the updated name for what was once known as artificial insemination.

Who Can Use IUI?

IUI is usually suggested for those couples who have been trying to conceive for a year or more without success and have been found to have infertility issues..In general, artificial insemination is used when:

A woman’s cervical mucus is scant or hostile to sperm. Through IUI, sperm directly reaches the uterus, bypassing the cervix and the cervical mucus.

The man has a low sperm count, though the sperm should be healthy.\r\n\r\nMale infertility due to antibodies in his own sperm. Sperm not damaged by the antibodies will be separated and used in the IUI process.

Ejaculation issues due to vaginal muscle contractions or psychological problems.

Retrogade ejaculation,  a condition where the semen goes back into the bladder rather than being expelled from the body.

Couples who cannot naturally have intercourse due to disability, injury or premature ejaculation.

How does IUI work?

In the process of IUI the fertilisation of the egg and sperm occurs naturally, although the sperm is given a kind of “push” or “helping hand” into the uterus. Intrauterine insemination can be performed with or without the use of fertility drugs. If fertility drugs are used it is called a “stimulated cycle” because the drugs stimulate ovulation. If drugs are not used it is called an “unstimulated cycle” or “natural cycle”.

IUI begins with an ultrasound check-up of the female to determine the size of the follicles that can mature into eggs. She is then given oral fertility drugs, if she has decided to use these, to help stimulate a greater number of egg follicles to mature.
Next, with the help of ultrasound scanning and blood tests to check for estrogen levels (estrogen is the hormone released by the female body to help the growth of the eggs), follicular growth is monitored. In women who have taken fertility medications, this also helps in individualising drug doses, keeping track of potential side effects and reducing the risk of multiple pregnancy.

In some cases, women undergoing IUI may receive an injection of human chorionic gonadotropin (hCG) hormone to stimulate egg growth and cause ovulation. Administering this hormone causes eggs to be released within 30 to 40 hours and provides a better assurance of an egg being present in the ovary when IUI takes place.

Timing is crucial when dealing with IUI, as sperm has to be injected at the precise time when ovulation has occurred or is about to occur.

Around the time of expected ovulation, a sample of fresh semen is collected from the male partner and processed in the lab by washing in a culture medium or using a density gradient column. This is done to obtain good quality sperm while minimizing the number of unhealthy, poor quality sperm. A prompt insemination after the processing is important to increase the success rate.

Sometimes a sperm sample taken at an earlier date may also be frozen and later used for IUI. Sperm is then inserted into the cervix and placed high inside the uterus by using a catheter. It is a painless procedure and does not take more than 20 to 30 minutes. Once insemination is done, regular ultrasound monitoring and pregnancy tests are performed to find out whether the process was successful.

Risk Factors of IUI

While IUI is a relatively straight forward process, like all medical procedures there are risks involved. Risks include infection, brief cramping of uterus or transmission of venereal disease from donor sperms. However, the strict quarantine applied nowadays by sperm banks has decreased the risk of viral transmissions dramatically.

The use of fertility drugs brings with it the risk of a multiple pregnancy. In order to reduce this risk, your doctor may stop your cycle midway. The chance of a miscarriage occurring and having a low birth weight baby is high in the case of multiple pregnancies.

Fertility medications may also cause a rare condition called ovarian hyperstimulation syndrome. Women affected by this will experience an enlarging of their ovaries and a collection of fluid in the abdomen. If this occurs, the IUI process may be stopped before insemination.

Success Rate of IUI

In a given cycle, the possibility of conception is 10% to 20% provided the sperm count is good and the female has a healthy fallopian tube. The woman’s age is also a deciding factor on the success rate, since advanced maternal age results in fewer follicles maturing into eggs.

Doctors usually recommend trying two to three IUI cycles before opting for another fertility treatment, such as IVF.

Cost of treatment: Compared to other fertility treatments, IUI is a lot less expensive.