IUI- Intrauterine Insemination
IUI
is a infertility treatment procedure in which semen is processed and the concentrated sperm
are placed into the uterus using a small catheter. Unwashed
sperm must not be placed in the uterus as severe allergic
reactions can occur. On the day of the IUI, the male partner produces a semen
sample. The sperm are then separated
(washed) from the seminal plasma, white blood cells,
 prostaglandins and other "debris" using a
density gradient.
In IUI, A speculum is inserted into
the woman's vagina and a catheter with a syringe containing
the concentrated sperm is inserted through the cervix
into the uterus. The sperm are injected and the catheter
and the speculum are removed. Intrauterine insemination is usually not
a painful procedure.
IUI
with FSH (Gonal-F, Follistim, Repronex) may be chosen dependent upon the cause(s) of the
couple's infertility, and many other factors. IUI success rates using FSH are usually higher because FSH causes the development of numerous eggs. Patients are
monitored by estradiol hormone measurements and transvaginal
ultrasounds to visualize the ovaries and follicles.
The IUI is planned around the time of ovulation. Once the follicles mature, an
injection of hCG is given to stimulate ovulation,
which occurs approximately 36 hours later. FSH stimulated
IUI cycles should only be conducted by an infertility
specialist , reproductive endocrinologist thoroughly
trained in the use of gonadotropins. Patients must be
carefully monitored to prevent medication side effects
and high order multiple births (>2).
IUI is often one of the first treatment choices in cases of mild male infertility. The sperm can be concentrated enough to make fertilization possible. However, in cases of moderate to severe male factor infertility, IVF and intracytoplasmic sperm injection are used in combination. Using the ICSI procedure a single sperm is inserted directly into the egg. The sperm can come from the ejaculate or be retrieved directly from the reproductive tract using microsurgical techniques such as TESA and MESA. This procedure makes it possible for men with very few, or no, sperm in the ejaculate to father a child. Some couples with severe male infertility opt to use donor sperm. Donor sperm is less expensive; however, child will not have the genetic makeup of the father.
Intrauterine insemination is also a "first line" treatment for women with cervical factor infertility. The cervical mucus may be too thick or thin or it may not be present in adequate quantities. Sometimes the woman's immune system may "mistake" sperm for invading pathogens. When this happens her body dispatches its natural defense mechanisms to destroy the sperm just as if it were a bacteria or virus. In IUI, the sperm is placed directly into the uterus thus avoiding the need for exposure to the cervical mucus.
We often hear reports of high order multiple births in the media and many times these stories are associated with fertility clinics. More often than not, these multiples are a result of IUI cycles conducted by a non specialist. Specialists carefully monitor IUI cycles and are trained to adjust medication dosages appropriately. However, high order multiple births can still result from an IUI cycle because there is little control over how many follicles will be ovulated. It is unusual for high order multiples (>3) to result from IVF because the physician controls the number of embryos transferred to the uterus.
IUI is less expensive than IVF,
but the per-cycle success rates are significantly lower.
If no pregnancy results after three cycles, in vitro
fertilization may be the next step.
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