Some infertile couples may have difficulty conceiving because of factors that make it difficult or impossible for the man’s sperm to reach the woman’s uterus. Pregnancy may occur if the woman undergoes insemination with her husband’s sperm. During this process, a physician places the husband’s semen into the woman’s uterus near the time of ovulation. This procedure, known as intrauterine insemination (IUI), is often recommended for couples who are infertile because of impotence or when the man has an excessively low sperm count, decreased sperm motility, or other sperm problems. It is also useful in couples with unexplained infertility and normal sperm counts. If the female is undergoing ovulation induction, IUI may significantly improve the chances of successful fertilization.
HOW IS SEMEN COLLECTED?
The sperm needed for IUI can be collected several ways. A man may masturbate into a sterile cup no more than one hour before a scheduled insemination appointment. This can be done in the privacy of home or at the doctor’s office.
When intrauterine insemination is used, it is necessary to separate the sperm from the seminal plasma. This removes prostaglandins and other substances that could cause adverse reactions or severe uterine contractions. In order to separate the sperm, a laboratory technician performs a sperm washing procedure. This involves diluting the semen with a sterile fluid and then separating the sperm from the liquid component. The sperm are then returned to a small amount of the sterile fluid which is used for the insemination procedure. Sperm washing attempts to remove chemicals and bacteria that can cause infections or adverse reactions when placed directly into the uterus. Additionally, the sperm washing procedure may increase the sperm’s ability to fertilize the egg.
THE INSEMINATION PROCEDURE
Inseminations are scheduled to occur around the time of ovulation. The time of ovulation is often estimated by ultrasound scans performed by your doctor. Inseminations are usually performed once or twice each month depending on the regularity of the menstrual cycle. The insemination procedure is relatively simple and only takes a few minutes to perform. The woman lies on an examining table and the physician inserts a speculum into her vagina. The semen sample is prepared (“washed”) and directly injected into the uterine cavity. This method may be used for several reasons, including poor sperm/cervical mucus interaction or to increase pregnancy rates. IUI allows the sperm to bypass the cervix so that an increased number can reach the uterine cavity and subsequently the fallopian tubes, where fertilization usually occurs. The physician usually prescribes drugs to induce ovulation. IUI may be performed in conjunction with these medications to increase the chances of successful fertilization. Recent data suggest that increasing the number of sperm reaching the fallopian tubes by intrauterine placement may also increase the pregnancy rate in couples with unexplained infertility, especially with the addition of ovulation drugs.
The success rate of IUI depends upon several factors. First of all, the cause(s) of the fertility problem is important. Men who have good sperm counts and high motility, but are unable to have intercourse or cannot achieve a pregnancy due to a cervical factor in the female partner; have a much higher chance of success than patients who are undergoing IUI because of sperm abnormalities. Female factors also play an important role. If the female partner is older than 35, the chances of a successful pregnancy are significantly decreased. The predictability of ovulation is also important. The more regular the menstrual cycle, the greater the chance of pregnancy. The presence of endometriosis or a history of pelvic infection or tubal disease decreases the success rate. Success is more likely if there has been a previous pregnancy. There is an approximate two to four percent chance of birth defects in all children born, including those resulting from IUI. Sperm washing and the insemination procedure do not increase or decrease this risk. The success rate of insemination may be as high as 15 percent per cycle, which is comparable to the chance that fertile couples have of conceiving during any given month.
INSTRUCTION TO PATIENTS
- Take medicines and injections as instructed by your gynaecologist at approximately the same time everyday.
- Frequent sexual intercourse during your treatment cycles is recommended. A minimum frequency of once every 2-3 days is advised.
- There is no restriction regarding sexual contact after the IUI.
- Daily activities, travel and diet need not be altered during the treatment cycle.
- In case of any further questions, please contact your doctor.