Semen Wash And Intra Uterine Insemination (IUI)

• Intra-uterine insemination (IUI) also known as Artificial Insemination is a process in which the washed/processed semen is placed into the uterine cavity with the help of a catheter in and around the time of ovulation (release of egg from the ovary)
• The purpose of IUI treatment is to introduce the best and the most motile sperms high up in the uterine cavity i.e. as close to the ovum as possible so that the sperms have to travel the least distance
• It also overcome factors like cervical mucus opposition for its entry into the uterine cavity
• It is always done with follicular monitoring, the egg is matured and released or about to be released, which ensures that both the egg and sperm are timed properly for optimum fertilization and increased chances of pregnancy
• IUI treatment should always be done after confirming tubal patency
• The egg is usually alive for 24-48 hrs. after ovulation. Sperms are alive for around 48-72 hrs after they are released into the female genital tract. Thus, if processed / washed semen sample is deposited around this time, the chances of conception are very high

What is the success rate of IUI ?

The success rate of IUI is averagely 12-15% but it depends on a several factors like women’s age, ovarian reserve, cause of infertility, duration of infertility, previous obstetric history, semen parameters and most importantly on stimulation protocol used.

Natural cycle IUI - 8-10%

Ovulation Induction with tablets and IUI-12-15%

Ovulation Induction with Injections and IUI-18-20%

Addition of GnRh antagonist increases the pregnancy rates further by 26-30%

Also more the no of pre-ovulatory follicles with good blood flow , better is the result.

What are Indications of IUI?

• Mild to moderate male factor infertility- low sperm count, low motility
• Unexplained infertility (No apparent cause found for inability to conceive on routine recommended medical testing)
• Sexual or ejaculatory dysfunction
• Retrograde ejaculation
• Increased semen viscosity
• Time constraint (Husband working abroad )
• Cervical factor
• Minimal endometriosis

How many cycles can one undergo ?

• In a young couple (age <35 yrs), 6 cycles of IUI Procedure with ovulation induction are advised whereas in an elderly couple (age>35 yrs) 3 cycles of IUI are advised.
• However with other factors like Endometriosis , it is advisable to restrict to 3 cycles.
• Cycles when done consecutively, that is back to back have better success rates.
• It is important to individualise each case.

What is Donor IUI Procedure (Artificial Insemination) ?

In cases of Azoospermia (No sperm count) or with severe male factor infertility, IUI is done with donor semen sample. The donor blood group and physical characteristics are matched.

Donor sample is procured from registered semen bank where donors are screened for viral infections.

What is the procedure for IUI ?

• It is started from Day 2 or 3 of menses. Ultrasound is done to rule out cyst and determine AFC
• Patient is started on tablets or injections for ovulation induction
• Serial monitoring of follicle growth is done on Ultrasonography from Day 8 or 9 of menses
• When a good dominant follicle of more than 18mm with good peripheral vascularity is formed, Injection is given for rupture of follicle
• 36 hrs after injection, IUI is done
• Luteal support is given with medications
• After 14 days, patient is called for follow up for the results

Why should semen be processed ?

Normally during intercourse the semen that gets deposited in the vagina contains seminal fluid (which helps to keep the sperms alive even in the acidic environment of the vagina) along with sperms. The cervix then acts as a barrier to this seminal fluid and allows only the motile sperms to enter into the uterus. The fluid that comes out after intercourse is the seminal fluid.

Only processed semen sample is used during IUI treatment. Processing helps to separate the active motile sperms from the seminal fluid and also from dead sperms, cellular debris, mucus, bacteria. This seminal fluid can be irritating to the uterine lining as it contains chemicals called Prostaglandins. Thus when the semen (unprocessed) is inserted directly into uterus, it could cause severe pain and cramping.

There are different techniques available for sperm processing:

• Swim –Up Wash
• Density Gradient Wash
• Simple Wash

More about IUI

• It is an OPD procedure and doesn’t require admission
• It is one of the first line treatment which is completely safe
• It is usually painless but in cases of severe discomfort, sometimes it can be done under anaesthesia.
• In cases of difficult IUI, IUI must be done under ultrasonography guidance with help of traction with allis. One may consider cervical dilatation or Hysteroscopy for the same
• Usually only one IUI is done per cycle but in certain conditions like repeated failures and male factor infertility, two IUI give better result
• IUI can be done using Frozen husband sample, when husband is outdoor for long durations