What is IUI?
IUI is commonly known as artificial insemination, intrauterine insemination. It is an outpatient procedure in which sperm from a woman’s partner or a donor is placed inside her uterus. IUI can be a viable option for single women, same-sex couples, women with cervical problems or abnormalities, or women whose male partner has a low sperm count or reduced motility.
IUI is a relatively easy and comfortable process that includes four phases, preparation, sperm collection, insemination, and a pregnancy test. It is essential to time the IUI procedure with ovulation. In some cases, ultrasound may be used to evaluate egg development in the woman’s ovaries, or she may need to take an at-home urine test to determine the right time for the procedure.
This process IUI is a relatively easy and comfortable process that includes four phases, preparation, sperm collection, insemination, and the pregnancy test. It is essential to time the IUI procedure with ovulation. It starts with the medications to stimulate ovulation. During the phase, the maturity of the eggs is monitored very carefully. Some women also receive an injection that stimulates the ovaries to release the eggs.
Sometimes human are also given chorionic gonadotropin (HCG) to help in the ovulation of one or more eggs at the right time. This process continues, and the next step starts when the male partner provides a sperm sample at the clinic unless donor sperm is being used. It is essential to process the sample between 30 minutes to an hour after collection to ensure the best possible results. If the sample is taken from donor sperm, it would be thawed and processed according to the procedure.
The insemination procedure is almost like a pap smear. The woman’s cervix will be cleaned with a cotton swab, and a small catheter holding the sperm sample would be placed into her vagina and pass the cervix. There is little if any discomfort, though some women do experience minor cramping or light vaginal bleeding. Following the procedure, the woman is asked to rest in a recline position for 10 to 15 minutes. After taking a rest, she can do the usual daily activities. After two weeks of the procedure, the woman takes a pregnancy test at home. For some women and couples, the IUI procedure may need to be repeated multiple times.
DURING THE PROCEDURE
The intrauterine insemination process takes about 15 to 20 minutes. The doctors make the woman lie on a table, and then her legs are put into the stirrups, and a speculum is inserted into the vagina. During the procedure, the doctor performs the following things:
- A speculum is inserted inside the vagina. It can cause slight pain.
- The doctor will connect a vial of the healthy sperm sample to one end of a catheter. A long, thin, and flexible tube is inserted inside the vagina through the cervical opening into the uterus.
- The sperm sample is then pushed inside the uterus; after that, both the catheter and the speculum are detached.
AFTER THE PROCEDURE
After the process of insemination, the doctor advises against lying on the back for few minutes. When the procedure gets done, the woman can get back to perform the usual daily activities. The woman can undergo some light spotting for one or two days after the procedure.
RESULT OF THE PROCEDURE
A woman is required to take an at-home pregnancy test after waiting for two weeks. The doctor might take a blood test to detect pregnancy hormones after fertilization. Testing before the appropriate time might give a result that is:
- False-negative- If the pregnancy hormone does not reach moderate levels, the test may show a negative result while the woman is pregnant.
- False-positive- If ovulation-inducing medication such as HCG is used, and if the medication still circulates inside the body, it can indicate a pregnancy. At the same time, a woman is not pregnant in real.
The doctor may advise returning about two weeks after the home kit results for a blood test that is more sensitive in determining pregnancy hormones after fertilization.
In case there is a negative result, and the woman does not get pregnant in the first attempt of IUI, the same procedure is repeated after a recommended period of three to six months.
RISKS THAT MAY OCCUR AFTER IUI AND FERTILITY TREATMENTS
There are chances that some complications may arise after undergoing IUI treatment or other fertility treatments. Some of them are explained below:
1. Risk of having multiple babies
Although the risk of conceiving twins or the multiple numbers of children is relatively shallow, it may happen. The side effect of fertility drugs taken during the IUI treatment is the reason for becoming pregnant with multiples. Multiple pregnancies can increase the risk of miscarriage, premature delivery, gestational diabetes, low birth weight, high blood pressure, complications during birth, etc.
2. Risk of ovarian hyperstimulation syndrome (OHSS)
The fertility drugs used in the IUI treatment may lead to the problem of ovarian hyperstimulation syndrome. Fertility drugs like Clomid letrozole are operated on before the IUI cycle to strengthen ovulation which induces ovaries to develop more than 20 follicles in a single try. Hyper ovulation may inflate the body’s oestrogen level that leads to inflammation of the ovaries. Extended ovaries can lead to bloating, severe abdominal pain, vomiting or nausea, and breathing issues.
3. Risk of infection
There might be a minor risk of infection during the IUI procedure as it involves injecting a thin tube through the cervix to put the sperm inside the uterine cavity. Some women may go through some pain or cramping at the time of insertion. There is a higher possibility during insertion that an injury may happen to the cervix causing acute pain, spotting or bleeding after the procedure. Therefore a doctor always advises rest for a few minutes after completing the procedure to minimize any possible distress.
Intrauterine insemination is an ordinary process and is regarded to be among the least intrusive methods. The side effects allied with the process are also very nominal. Most of the side effects of IUI treatment generally diminish with time, or it gets eradicated after the stoppage of fertility medications.
Why is IUI done?
The pregnancy of a woman depends on numerous factors. Intrauterine insemination is mainly preferred by the couple who have the following problems:
- Donor sperm- Some women are required to use donor sperm to get pregnant. IUI is the most common method used to achieve pregnancy. Frozen donor sperm specimens are available in certified labs and thawed before the IUI procedure.
- Unexplained fertility- Some couples suffer from infertility, and the reason is undetermined. IUI is generally performed as the first treatment for undetermined infertility following ovulation-inducing medications.
- endometriosis-related infertility- When the infertility problem is associated with endometriosis, using medications to procure a good-quality egg following performing IUI is usually the first treatment approach.
- Mild male factor infertility (subfertility)- Semen analysis is one of the first steps in the medical assessment of infertility. The analysis may show average sperm concentration, weak movement (motility) of the sperm, or abnormalities in sperm size and shape (morphology). IUI can overcome some of these problems because preparing sperm for the process helps split the highly motile, normal sperm from those of lower quality.
- Cervical factor infertility- The cervix presented at the lower end of the uterus provides an opening between the vagina and uterus. At the time of ovulation, mucus is produced by the cervix to provide an ideal environment for the sperm to proceed from the vagina to the fallopian tube. If the cervical mucus is too thick, it can create difficulty for the journey of the sperm. The cervix may hinder the sperm from reaching the egg. Due to a biopsy and other procedures, sometimes the cervix gets thicken. IUI helps this problem, as in IUI, the sperm is directly inserted inside the uterus and increasing the number of sperm available to meet the egg.
- Ovulatory factor infertility- IUI is also beneficial for women who have infertility problems with ovulation. IUI also helps to solve if there is the issue of absence of ovulation or reduced number of eggs.
- Semen allergy- Although it is infrequent, a woman may have an allergy to her partner’s semen. Ejaculation inside the vagina sometimes causes redness, burning and swelling when the semen comes in contact with the skin. If the sensitivity is very severe, then IUI is beneficial, as most of the proteins in the semen are removed before inserting the sperm.
RISKS INVOLVED IN IUI
The risk of significant complications in this process is generally low as Intrauterine insemination is a straightforward procedure. Risks include the following:
- Infection- There are meagre chances that infection may occur as a result of the procedure.
- Spotting- During the process, placing the catheter inside the uterus sometimes causes a small amount of vaginal bleeding. But usually, it does not have any effect on the chance of pregnancy.
- Multiple pregnancies- IUI itself is not associated with a higher risk of multiple babies during pregnancy.
PREPARATION FOR IUI PROCEDURE
- Preparing the semen sample- Firstly, the doctors take the semen sample of the male, or the frozen donor sperm is thawed and prepared. Because non-sperm elements can cause reactions inside the woman’s body that hinder fertilization, the sample is washed so that the highly active, normal sperm from lower quality sperm and other elements are separated. If only a tiny amount of highly concentrated sample of healthy sperm is used, the chances of pregnancy increase.
- Monitoring for ovulation- As the timeframe of IUI is very significant, supervising for indications of imminent ovulation is essential. Some people use an at-home urine ovulation predictor kit that detects the body generates a surge or releases luteinizing hormone (LH). Or sometimes, the doctor visualizes the ovaries and egg growth through transvaginal ultrasound. The doctor sometimes injects human chorionic gonadotropin (HCG) or medications to ovulate one or more eggs at the right time.
- Determining optimal timing- Most of the IUIs are done a day or two after detecting ovulation. Doctors always have a plan outlined in detail for the timing of the procedure and what to expect.