INTRA UTERINE INSEMINATION (IUI)

IUI involves placing the processed sperm from a male partner/donor high into the uterus (womb) by means of a small plastic catheter. This insemination procedure is timed to coincide with the time of egg release in order to increase the chances of pregnancy.

Indications for IUI

1. Unexplained infertility, i.e. where all standard tests are normal and the couple is still not successful in achieving a pregnancy.
2. Mild abnormalities in the sperm parameters such as slightly low count, low motility and morphology.
3. Mild Endometriosis
4. Coital difficulties
5. HIV
6. Hepatitis B/C
7. Discordant couples

1. Ovarian stimulation
In the first step, the ovaries are stimulated, by giving clomiphene tablets or hormone injections with a view to produce more than one egg and improve the chances of pregnancy.

2. Monitoring egg growth with ultrasound
Each follicle is a small fluid filled sac containing the egg and its growth in response to the medication is monitored with internal (transvaginal) scans. Three or four scans might be needed over the course of one treatment cycle.

3. Egg release
When 1 - 3 follicles reach the mature size (i.e. measure more than 18mm in diameter on ultrasound scan), an injection called HCG is administered which will cause ovulation to occur approximately 36 hours later.

4. Insemination
Insemination is usually performed the day after the HCG injection. The healthy and best swimming sperm are separated from the semen by special preparation techniques and used kept in the incubator until ready to be inseminated.

The insemination procedure is not painful and usually takes about 5 minutes. The sperm is placed high into the womb using a fine soft tube called a catheter. You will be advised to lie down for 15 minutes following the procedure.

5. Luteal Phase
Usually progesterone tablets are prescribed for supporting the womb lining following the IUI procedure for about two weeks. You do not need bed rest during this period and can carry on with your routine activities as usual.

6. Follow Up
You will be advised to attend the clinic one week after your missed period to confirm whether you have achieved a pregnancy or not. However, if you get your periods on time, the treatment has not worked for you and the next cycle of treatment can be started on the 2nd day of the period.

If your test is positive, you must continue taking the progesterone support until the 12th week of pregnancy. An ultrasound scan can be performed after two to three weeks to confirm that the pregnancy is developing normally in the womb.

After three cycles, if no pregnancy has been achieved, it is important to discuss further treatment options.

Success of IUI
In general, with one cycle of IUI the pregnancy rate is around 15%. Upto 6 cycles of IUI could be tried before moving to IVF though most of the pregnancies resulting from IUI occur within the first 3-4 cycles of IUI treatment.