Normally the sperm are deposited in the vagina from where they travel through the first barrier, the cervix. Here the poor quality sperm get trapped and the healthy sperm crosses the barrier. Sometimes the cervix does not allow even the healthy sperm to cross and creates a hostile environment for the survival of these sperm, a problem which is rightly called Cervical Hostility. IUI is performed to bypass this barrier and deposit the clean healthy prepared sperms directly inside the uterus.
Females having irregular menstrual cycle and thus irregular ovulation time can be monitored and IUI is performed at an opportune time to optimize the chances of pregnancy.
IUI is also helpful to the couples suffering from unexplained infertility of short duration (less than 2 yrs) where no apparent cause is found following a battery of diagnostic tests.
Couples having difficulty in adequate sexual performance can also benefit from IUI if the primary objective is conception. It can help the females to conceive bur suffering from vaginismus.
If the husband has had his semen sample preserved prior to going outstation, vasectomy or some other medical treatment such as cancer therapy, which renders him sterile, then his frozen sample can be used for IUI.
Prior to IUI the husband’s semen is prepared in the laboratory so that the motile sperms are washed free of the seminal fluid and concentrated in a small quantity of culture media. This prepared sample is loaded in a fine catheter. The catheter is then passed through the cervix into the uterine cavity and sperms are gently expelled.
This begins with an in-depth discussion of their fertility problems and the treatment received so far. Complete physical examination is then performed and in most of the cases an ultrasound examination is carried out at the same time. Based on the history and previous investigations, further investigations are advised or alternatively various treatment modalities are discussed. Initial consultation can take one to two hours of consultation time, and one hour of embryologists time to prepare a report of semen analysis.
Treatment and Management:
The female patient is prescribed drugs to stimulate her ovaries. If only tablets are given for stimulation then careful monitoring is not essential and one or two scans, each of fifteen minutes duration, are performed in the course of the treatment cycle. For patients requiring injections for stimulation of their ovaries careful monitoring of the effect of the drug is done through repeated ultrasound scans. At a suitable time when the follicles are mature, the female patient is given an injection to ripen the eggs and the following day, the couple is asked to come to the clinic and bring a fresh semen sample from home (or a comfortable private place is provided to them for sample production). The couple is then asked to wait in the waiting area for one hour during which time the semen sample is prepared. This sample is processed in the laboratory to discard slow moving sperm and concentrate the very fast moving sperm. The wife is then placed in a comfortable position and fully covered to keep her modesty intact. The prepared semen sample is then loaded in a fine, soft catheter and the catheter is placed very gently at the mouth of womb and contents discharged into the cavity of the womb with the help of the attached syringe. The patient is asked to lie on the bed for 30 minutes after the procedure. IUI is performed twice, 24 hours apart. The success rate of this procedure is about 8 – 10% with drugs given as tablets and 15 -20% when stimulatory drugs are given as injections. The success rate improves slightly after the second attempt but onward the success rate per cycle remains the same.