Couples who wish to conceive but face fertility issues need not give up on their dreams. There are several fertility treatments and options to conceive. Intrauterine insemination is a fertility procedure that is typically quick and painless. But understandably, there are questions about this treatment. Would it hurt? Would there be a lot of cramping afterwards? Could something unexpectedly go awry? 

To answer these and other similar questions about Intrauterine Insemination (IUI), TC46 connected with Fertility Specialist Dr Apurva Amarnath Dr Apurva Satish Amarnath from Nova IVF Fertility, Bangalore. Here, he explains how IUI works, the risk factors involved, the success rate and the procedure.

1. What is Intrauterine Insemination (IUI)? What is the difference between IUI & IVF?

IUI is the process of insertion of processed sperm into the uterus, which helps healthy sperm get closer to the egg to aid fertilization. IVF would entail stimulation of ovaries to grow the follicles, following which an ovarian follicular aspiration is done and the harvested egg is fertilized in the lab with the sperm.

2. Who qualifies for this fertility treatment and when is it used?

The current indications of IUI are: 

  • Unexplained infertility
  • Mild male factor
  • Ejaculator/erectile dysfunction
  • If donor sperm insemination is required
  • here intercourse is to be avoided i.e. HIV infection

3. How can an IUI cycle help to improve the chances of pregnancy? Is there a risk for twins or triplets with IUI?

The chances of natural conception per cycle vary between 6-8%. IUI helps in improving the pregnancy rate to 15-20% by increasing the proximity of the egg with the sperm. When combined with ovulation induction, there is a 10-12 % risk of multiple pregnancies.

4. What are the different treatment cycles of IUI and what do they include?

IUI is usually done in combination with ovulation induction. The various protocols used would be using medication(tablets), injections or a combination of the two, depending on the patient condition. This includes starting the medication on D2/3 of a cycle, follicular monitoring, triggering ovulation when the dominant follicle reached the appropriate size followed by the IUI

5. What entails the procedure for IUI?

The procedure of IUI is simple. It entails:

  • Selection and counselling
  • Ovarian Stimulation
  • Monitoring of follicular growth and endometrial development
  • Timing of insemination is planned ~ 36 hours after the trigger injection
  • Sperm preparation
  • Insemination

On the day of the planned IUI, an ovulation check is done, following which the partner’s semen sample is collected, analyzed and processed. Once the sample is prepared, the female partner is positioned, and the insemination is done using a thin catheter into the uterus. A short period of rest is given following which the patient is free to go home.

6. What are the risk factors involved in this fertility treatment? What does the preparation for IUI look like? Which tests does one need to get done?

IUI is a low-risk procedure, most complications are associated with ovulation induction such as multiple pregnancies and OHSS.

There is no major preparation required for IUI. It’s an OPD procedure that takes barely 10 minutes. Prior to IUI, the couple is first evaluated – The female partner: USG for check of the antral follicular count and uterine status, blood tests for general health and hormonal status, Ie haemoglobin, blood sugars, thyroid status and FSH, LH, E2 if indicated. A test for tubal patency – HSG is also done. The male partner would need to get a semen analysis done. 

The prerequisites for IUI:  

  • At least one patent tube
  • A normal uterine cavity.
  • Normo or hypogonadotropic profile
  • Regularity of periods not relevant
  • Pre-Processing sample with:
  • TMSC > 10 million/ejaculate
  • Motility 30-50 %
  • Morphology >2.5 %
  • Post-processing sample
  • IMC >5 million motile sperm

7. What are some potential challenges that can hinder the process of IUI? Is IUI painful? What can a woman expect from this fertility treatment?

Difficulty in catheter insertion is the commonest difficult encountered. This is commonly seen in patients with a cervical condition such as previous cervical surgeries, cervical atresia

IUI is not a painful procedure, there can be mild discomfort at the time of insertion but passes in a few minutes. 

8. What is the success rate of this fertility treatment and what are some ways couples can increase their chances of successful IUI?

The success of this treatment is dependent on multiple factors.

  • Age of the patient – younger age, higher success
  • Duration of infertility – shorter duration, higher success
  • Cause of infertility
  • Primary or secondary infertility – secondary has a higher chance of success
  • Number of previous treatment cycles
  • Overall success is 15-20%, with success being 20-25% with donor insemination