Intrauterine Insemination (IUI) is one of the methods of artificial insemination. It is a simple and safe treatment option in infertility and is aimed at overcoming any natural barriers to the passage of the sperms from the vagina to the fallopian tubes.
During an IUI procedure, a prepared semen sample with adequate numbers of motile and normal sperms, suspended in a nutrient medium, are directly placed in the uterine cavity, thus by-passing the need for sperms to travel from the vagina to the uterus. This is done around the predicted time of ovulation. With IUI, the number of sperms that reach the fallopian tube can increase by as much as 25%.
Intrauterine Insemination is undergone in the following cases when the male partner has sexual problems like premature ejaculation, impotence, or when the semen quality is low in terms of count and motility; or when the cervix of the female partner is hostile to sperms, thus destroys them (which would be evidenced by certain tests) or there is a unilateral tubal block observed.
The partners are initially advised certain tests and investigations. Through a comprehensive analysis of history, examination and laboratory investigations the following facts are first confirmed by the clinician:
IUI may be performed at the time of ovulation in a natural menstrual cycle or in a cycle where the ovaries have been stimulated by drugs. Ovulation induction or stimulation of the ovaries is the administration of certain drugs that stimulate the ovaries to produce more eggs, thus improving the chances of conception. The woman is asked to come to the clinic on the second day of her menstrual cycle. After an ultrasound examination to check her uterus, she is prescribed medication to stimulate her ovaries.
To predict the time of ovulation, the woman will have to undergo ultrasound examinations on alternate days from the 8th or 10th day of her cycle. At the predicted time of ovulation, insemination is carried out with the prepared semen sample. Sperms have the ability to fertilize for up to 48 hours and a mature egg is capable of being fertilized for approximately 12 to 18 hours after ovulation.
For the male partner, abstinence is observed 3 to 4 days prior to the procedure. On the day of the insemination the husband gives a semen sample in a wide-mouthed sterile container provided by the clinic. Facilities ensuring privacy are available at the clinic for this purpose.
After the specimen has been given for processing, the couple can leave and return for the insemination 1 to 2 hours later. The semen sample is assessed for volume, count and motility. The semen is then washed, which in essence refines and concentrates the sperms and enhances the fertilizing capacity. Only motile normal sperms are obtained, thereby eliminating all other contents. The sperms are suspended in a nutrient medium and this sample is used for insemination.
Frozen semen of the husband may also be used for insemination. This is done when the husband cannot be present at the time of insemination.
IUI is a relatively simple and straight forward technique performed trans-vaginally as an outpatient procedure. There is no pain during the procedure. There is no need for the woman to fast or rest before the insemination procedure. The woman is asked to pass urine so that her bladder is empty. She lies on a couch or bed with her hips raised on a pillow. The IUI catheter with the processed semen sample is gently introduced into the uterus. The processed semen is injected slowly into the uterus in over 30 to 60 seconds. The woman is asked to continue lying down for the next 30 minutes. She is then allowed to leave and can resume her routine activities immediately on return.
After IUI, the female partner is prescribed medication which helps make the uterine lining or endometrium receptive to implantation of an embryo. There is no restriction in activity. There is no need for bed rest, diet or travel restrictions.
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