IVF

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  • Overview
  • Benefits
  • When is it done?
  • When is it not done?
  • Natural Cycle IUI vs COS IUI cycles
  • Evaluation Prior to IUI
  • Success Rates

Overview

Intrauterine insemination, also known as artificial insemination, is a fertility treatment procedure that involves placing specially washed and prepared sperm directly into the uterus, bypassing the cervix. This procedure is timed to coincide with a woman’s ovulation, maximizing the chances of fertilization and pregnancy.

If the male partner has problems like Sexual dysfunction, premature ejaculation, Abnormalities in Penile curvature etc or in cases of mild male factor infertility (like decreased sperm count or motility), in such cases an IUI procedure may be preferred. The success rate of treatment with AIH is high if this is the couple’s primary infertility issue.

Intrauterine insemination (IUI) is a valuable treatment option for couples facing infertility challenges. It offers a simple and effective method to increase the chances of successful fertilization and pregnancy. By providing a controlled environment for sperm placement and timed ovulation, IUI addresses various fertility factors, such as mild male factor infertility, cervical issues, or irregular ovulation. Consulting with a fertility specialist is crucial to determine if IUI is the right choice based on individual circumstances and to discuss its potential benefits in achieving pregnancy.

Benefits

Increased Sperm Concentration: By directly depositing prepared sperm into the uterus, the concentration of sperm reaching the fallopian tubes is significantly higher than with natural conception. This enhances the chances of fertilization.

Timed Ovulation: IUI is carefully timed to coincide with a woman’s ovulation, ensuring that the sperm is present in the reproductive tract when the egg is released. This precise timing maximizes the likelihood of successful fertilization.

Improved Sperm Quality: Prior to IUI, the sperm sample is washed and prepared, removing any impurities and non-motile sperm. This selection process ensures that only the healthiest and most motile sperm are used, enhancing the chances of successful fertilization.

Minimally Invasive Procedure: IUI is a minimally invasive procedure that does not require surgery. It is generally well-tolerated, with minimal discomfort during and after the procedure. It also has a low risk of complications.

Cost-Effective: Compared to more advanced fertility treatments such as in vitro fertilization (IVF), IUI is a relatively more cost-effective option for couples with certain infertility factors.

When is it done?

IUI may be recommended in the following situations:

Unexplained Infertility: When no clear cause for infertility has been identified, IUI can be an initial treatment option.

Mild Male Factor Infertility: If the male partner has a low sperm count, decreased motility, or mild sperm abnormalities, IUI can help facilitate the sperm’s journey to the fallopian tubes, increasing the chances of fertilization.

Cervical Factor Infertility: In cases where the cervix poses a barrier to sperm entry or if the cervical mucus quality is suboptimal, IUI can help bypass these challenges.

Ovulation Disorders: Women with irregular or absent ovulation patterns may benefit from IUI when combined with ovulation induction medications. These medications stimulate the growth and release of mature eggs, improving the chances of successful fertilization.

Endometriosis-Related Infertility: IUI can be considered for couples where endometriosis is present but not severely affecting fertility.

When is it not done?

While IUI is helpful for a number of patients experiencing infertility that hope to conceive, there are certain situations in which it’s not an ideal treatment option. This includes the following cases:

  • Severe male factor infertility
  • Females with both fallopian tubes blocked
  • or Disease affecting the fallopian tubes
  • Medical history of pelvic adhesions
  • Females with severe pelvic infection
  • Males with less than 1 million sperm count in post semen wash
  • Severe endometriosis

IUI is not an option if Male partner is suffering from ejaculatory disorders like anejaculation or retrograde ejaculation or severe male factor infertility in which case, we can’t obtain a sample for IUI.

In addition, people who have had not achieved success with IUI after multiple IUI attempts in the past will have other fertility treatments recommended to them. IUI isn’t usually recommended for intended mothers over 40.

Natural Cycle IUI vs COS IUI cycles

IUI can be carried out in natural cycles or in combination of Controlled ovarian stimulation. Ovulation stimulation is recommended for women with ovulatory disturbances,

Ovarian stimulation helps overcome subtle defects in ovulatory function and luteal phase as well as enhances steroid production, which may improve the chances of fertilization and embryo implantation. However, excessive follicular development is usually associated with very high estradiol levels which may lead to two important complications: ovarian hyperstimulation syndrome (OHSS) and multifetal pregnancy

Therefore, in order to maximize the probability of successful conception while minimizing the risks of OHSS and multiple pregnancies, controlled ovarian stimulation is essential.

The goal of COS is to induce the development of one or two mature oocytes.

Clomiphene citrate and gonadotropins are the two commonly used drugs for ovarian stimulation in IUI.

  • Compared to natural cycles, stimulated cycles have a much higher pregnancy rate.
  • In couples with unexplained infertility, ovarian stimulation with IUI has shown higher conception rates compared to IUI alone.
  • In couples with male subfertility or cervical factor infertility, studies show no significant difference in the pregnancy rates with IUI alone and IUI with ovarian stimulation.

Evaluation Prior to IUI

The following evaluations will be performed in advance of the insemination procedure:

When appropriate, evaluation of the partner or husband may involve a medical consultation, physical examination, and, in all cases, laboratory tests (tests for infectious diseases should be performed within six months of the procedure, if at all possible). These tests might involve, but not be limited to:

  • Serological study for syphilis
  • Sperm analysis
  • Blood group and RH
  • Surface antigen for hepatitis B
  • Hepatitis C antibodies
  • HIV type 1 and 2
  • Presence of Neisseria Gonorrhoeae
  • Presence of Chlamydia

The evaluation of women may consist of the following:

  • Medical past, sexual history, and preconception
  • Extensive medical examination
  • Laboratory examinations (certain tests for infectious illnesses
  • should be conducted within six months following the surgery), which may include:
  • HIV-1 and 2
  • Syphilis
  • RH
  • Blood group
  • Neisseria Gonorrhoeae
  • Chlamydia Trachomatis
  • Surface antigen for Hepatitis B
  • Antibodies for varicella
  • Antibodies for rubella virus
  • Hepatitis C antibodies
  • IgG antibodies to cytomegalovirus

Success Rates

The main factors to consider for the success rate of IUI is the woman’s age and the semen parameters. IUI success rates decrease with advancing age of the female partner

  • For women in their early 30s or younger, the success rate after one round of IUI is around 15-20%.
  • For women aged 30 to 35, the success rate of Intrauterine Insemination is typically around 10-15%
  • Women aged 35-40 have a 10% success rate of becoming pregnant after IUI. By their early 40s, the success rates drop to approximately 5%.
  • If male factor infertility is also factored in, IUI success rates are around 16.9%.
  • If you are experiencing unexplained fertility with healthy eggs and two open fallopian tubes, IUI success rates are around 7% to 10% per cycle.
  • If you use IUI treatment in combination with fertility medications your success rate increases by 15-25%.

Procedure

The Intrauterine Insemination (IUI) procedure involves several steps to ensure optimal conditions for successful fertilization. While specific protocols may vary slightly between fertility clinics, here is a general outline of the steps involved in an IUI procedure:

1Baseline Assessment

This is done on day 2 of your period . Prior to initiating COS, a comprehensive evaluation is conducted, which may include a physical examination, blood tests, and ultrasound imaging to assess the baseline ovarian reserve, hormone levels, and overall reproductive health.

2Controlled Ovulation Stimulations

Following the baseline assessment, Ovulation inducing of medications is prescribed to stimulate the growth and maturation of eggs. You will need to take the medicine for a specified number of days, which depends on the type of stimulation protocol.. Oral medication is taken regularly for 5 days, and injectable medication is generally taken for 8-12 days based on the response of the ovaries. This step can be skipped if you are undergoing a Natural cycle IUI,

3Follicular Monitoring

Prior to the IUI procedure, the woman’s menstrual cycle is closely monitored. This typically involves regular ultrasounds and hormonal blood tests to track the development and maturation of follicles (fluid-filled sacs containing eggs) in the ovaries. Some women may be given medications to trigger ovulation once the developing follicle reaches a desired size.

4Timing of the Procedure

Once the ultrasound and hormone tests indicate that the woman is nearing ovulation, the IUI procedure is scheduled. Timing is crucial to ensure that the insemination occurs at the most fertile period of the woman’s cycle. In some cases, a repeat IUI is done the next day after the ovulation is confirmed over ultrasound.

5Semen Collection

On the day of the IUI procedure, the male partner provides a semen sample at the clinic. The Husband should refrain from having any sexual activity for around two days, if possible. The semen is collected through masturbation into a sterile cup provided by the fertility clinic. A back sample is taken at the start of the IUI cycle and frozen to be used in case the husband sample is unable to give an adequate sample on the day of IUI. In IUI with semen donor a donor sperm sample may be used.

6Semen Preparation

The collected semen sample undergoes a process called sperm washing or sperm preparation. It involves separating the sperm from the seminal fluid, removing impurities, and concentrating the healthy, motile sperm.

7Insemination

With the prepared sperm sample ready, the IUI procedure takes place. The woman lies on an examination table, similar to a pelvic exam. A speculum is inserted into the vagina to visualize the cervix. If necessary, the cervix may be gently cleaned with a sterile solution.

Catheter Insertion: A thin, flexible catheter is then carefully inserted through the cervix into the uterus. This is typically a painless or minimally uncomfortable procedure. The catheter is advanced to the appropriate depth within the uterus.

Sperm Transfer: The prepared sperm sample is loaded into a syringe connected to the catheter. The sperm is slowly and gently injected into the uterus through the catheter. This allows the sperm to bypass the cervix and enter the uterine cavity directly.

8Luteal Phase Support

A week after ovulation, progesterone levels are often tested. Progesterone support is often used for women with recurrent miscarriage. Progesterone support (to support the luteal phase) promotes embryonic implantation and pregnancy maintenance. Depending on the dosage of progesterone and the patient’s circumstances, the administration method may be intramuscular, vaginal, or oral. Progesterone dosages are given every day until a pregnancy is confirmed. The administration of progesterone is continued for at least six weeks if the woman is expecting.

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Frequently Asked Questions (FAQ’s)

Yes, IUI can be attempted for women with low anti-Müllerian hormone (AMH) levels. However, it’s important to note that the success rates of IUI may be lower in women with low AMH levels compared to those with normal or higher levels.

AMH is a hormone produced by the follicles in the ovaries, and it is often used as an indicator of ovarian reserve. Low AMH levels may suggest a lower quantity and quality of eggs available for fertilization. However, it doesn’t necessarily mean that pregnancy is impossible or that IUI cannot be attempted.

The decision to proceed with IUI in women with low AMH levels depends on individual factors and should be discussed with a fertility specialist. The specialist will consider other factors such as the woman’s age, overall health, previous fertility history, and any other underlying causes of infertility. They will provide personalized guidance on the most appropriate treatment options and discuss the potential success rates.

In some cases, if the AMH levels are extremely low or if there are other significant factors affecting fertility, the fertility specialist may recommend alternative treatments such as in vitro fertilization (IVF) or other advanced reproductive techniques that may offer higher success rates.

It’s important to consult with a fertility specialist who can evaluate your specific situation, provide accurate information based on your medical history, and guide you towards the most suitable treatment options for your individual needs.

A single open fertility tube means one of the fallopian tubes is blocked. Pregnancy can occur but the success rate depends on the location of the blockage. If the blockage is near the ovary, the IUI success rate is 11.7%. If it’s close to the uterus, the chances of success are a little higher.

IUI is usually recommended for couples under 35 who Struggle to conceive naturally. This is because women under 35 can fulfill certain criteria which are prerequisites of IUI namely:

  • women with healthy fallopian tubes, healthy endometrium and uterine cavity.
  • Intended fathers without severe male factor infertility
  • Intended mothers using a sperm donor

The IUI procedure itself usually takes only a few minutes. However, you may need to spend some time at the clinic for preparation and post-procedure rest. Overall, plan for a couple of hours for the entire process.

Maintaining a healthy lifestyle is important during an IUI cycle. It is advisable to follow a balanced diet

IUI is usually a minimally invasive and relatively painless procedure. Some women may experience mild discomfort, similar to menstrual cramps, during the placement of the catheter. Pain medication is typically not required for the procedure.

IUI is a generally safe procedure with minimal risks. Some potential side effects may include mild cramping, spotting, or a small risk of infection. Multiple pregnancies can occur if more than one follicle is stimulated or if fertility medications are used.

The number of recommended IUI cycles before considering other options depends on various factors, including age, overall health, underlying fertility issues, and previous treatment outcomes. Typically, it is common to try three to six cycles before assessing other alternatives.

  • Women younger than 35 have a 10 to 15% chance of pregnancy after one round of intrauterine insemination.
  • For women between the ages of 35 and 40, the odds are approximately 10%, and
  • for women older than 40, there is approximately a 2 to 5% chance of pregnancy after one round of IUI.
  • However, studies indicate that the odds of getting pregnant with 3 to 6 cycles of IUI is as high as 80%.

It is important to inform your fertility specialist about all the medications you are taking, including prescription and over-the-counter drugs, before starting an IUI cycle. In most cases, certain medications can be safely continued during the IUI cycle, while others may need to be adjusted or temporarily stopped. Your fertility specialist will provide specific guidance based on the medications you are taking and their potential impact on the IUI procedure.

Your fertility specialist may recommend abstaining from sexual intercourse for a certain period before and after the IUI procedure. Typically, it is advised to avoid intercourse for around 24 to 48 hours after the procedure to allow the sperm to stay in the uterus and increase the chances of successful fertilization. However, it is essential to follow your doctor’s instructions as recommendations may vary based on individual circumstances.

The timing of a pregnancy test after IUI can vary depending on the specific protocol followed during the cycle. Generally, it is recommended to wait for about two weeks (14 days) after the IUI procedure before taking a pregnancy test. Testing too early may result in a false-negative result due to the time required for the fertilized egg to implant and for pregnancy hormones to build up in the body.

Some women may experience mild spotting or light bleeding after an IUI procedure. This can be caused by the manipulation of the cervix during the procedure or other factors. In most cases, spotting or light bleeding is normal and should resolve on its own. However, if you have concerns or if the bleeding is heavy or accompanied by severe pain, it is important to contact your fertility specialist for further evaluation and guidance.

While there is no strict bed rest requirement after an IUI procedure, some fertility specialists may recommend a short period of rest to allow for relaxation and recovery. This may involve avoiding strenuous activities and minimizing physical exertion for a few hours or up to a day after the procedure. However, it’s important to note that excessive bed rest is not typically necessary and may not improve the success rates of IUI.

If IUI is unsuccessful, the next steps will depend on various factors such as the number of previous attempts, age, underlying fertility issues, and the specific recommendations of your fertility specialist. Your doctor may suggest repeating IUI cycles with adjustments to the treatment protocol, exploring alternative fertility treatments such as in vitro fertilization (IVF), or further investigating and addressing any underlying fertility factors. The best course of action will be discussed with your fertility specialist based on your individual situation.