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Intrauterine Insemination

Introduction

It is a process that inseminating processed sperm using laboratory procedures to isolate the active sperm from the seminal fluid, less active and immotile sperm.

Concentrated active sperm will be inserted into the uterus of a woman using catheter on the day of ovulation was expected to occur.

History

IUI was first done first on animals and then in humans.

IUI procedure was performed on the animals begin in the fourteenth century when the Arabs used to breed stallions.

At the end of 1784, Lazarro Spallanzani was the first  used this technique to breed dogs.

In year 1793, London, John Hunter was the first person reported to achieve a successful human pregnancy by using IUI. Although Hunter receives credit for the first human pregnancy using the procedure, it is possible that there were success attempts before.

Preparation     

Preparation steps before starting a cycle of IUI.

Before treatment is started there are a few steps that will be implemented to ensure you are ready.

Step 1

Pathological investigation for women and men.

Step 2

Patients will be given counseling first. Those who have fertility problems will perform some investigation before starting IUI.

Step 3

Appointment of units to facilitate doctor fertility expect to get a date period and doctors or nurses will teach injecting the drugs.

Preparation  for a  IUI procedure

In IUI , the woman must undergo ovarian stimulation with clomiphene citrate by  taking pills from day two to day six menstrual periods or gonadotropin injections every day.

When the follicles have reached a diameter of 18 mm , hCG injection will be given to mature the eggs ripen and  hCG injections are usually given at 9 pm and will proceed IUI in 36 hours later.

On the day of IUI  procedures, the male partner have  to produce semen by mastubation. Then, the semen sample will be processed by andrologist or
embryologist.

Here are some important things that need to be noted:

  1. Keep containers or bottles for collection of semen is clean and dry.
  2. Avoid sexual conduct (abstinent), at least 3 – 5 days prior to sample collection.
  3. Ideally semen sample collection was done by masturbation.
  4. Make sure all the semen is inserted into the container or bottle that has been provided.
  5. Avoid using other containers, such as a condom, because chances of contain substances that can contaminate semen.
  6. Sample should be send at least 1 hour after collection to the laboratory
  7. Avoid semen is exposed to temperatures that are too cold or hot.
  8. Notify if ever get sick or take any medication in the previous 2 months.
  9. Wash your hands before removing sperm.
  10. Avoid adopt a lubricant or soap.
  11. Avoid semen from spilling.

Andrologist or  Embryologist will be responsible for processing semen to isolate plasma and immotile sperm cells.

Sperm selection process is done by adding a special media and a series of centrifugation. The final solution concentrated with active sperm and will be inseminated into the uterus.

IUI procedure will not require anesthesia and it is almost like a pap smear.

Speculum is used to open the vaginal . This allows the doctor to insert the catheter into the cervix. The whole procedure taken only 5 minutes to complete.

After IUI, patients need luteal support medication to  maintaine endometrium thickness and enhance implantation

The following points should be noted:

  1. Plenty relax and avoid doing excessive physical activity. However, it is not necessarily to rest in bed.
  2. Drinking enough water
  3. Avoid taking medication without consult with your doctor.

A pregnancy test (UPT) will be performed 2 weeks after the procedure to determine pregnancy status.

Purpose          

The purpose is to achieve by other means of normal fertilization (sexual) to achieving pregnancy.

Who can benefit from IUI         

Indications to perform IUI are as follows:

  1. Having a normal uterus
  2. Fallopian tubes are not blocked
  3. Anovulation
  4. Insufficient cervical fluid
  5. Endrometriosis
  6. Sufficient motile sperm
  7. Factor immunology (antisperm antibodies)
  8. Unexplained infertility

Protocol             

Can be carried out with or without the use of fertility drugs according to the circumstances and your condition.

There are three main protocols for IUI as follows:

  1. Natural

    A natural cycle is recommended to secondary infertility and difficulty with sexual intercourse.
     

  2. Cycle use of fertility drugs such as clomifene (Clomid )

    Normally, patients is suggested to take clomid medication on the second day  to day  six menses to stimulate the ovaries. It will cause some dominant egg grows and maturity.
     

  3. Cycle using hormone injections or gonadotrophins (Gonal -F , Puregon and Menopur)

    It usually it is recommended when infertility is unexplained or mild male factor. Injection is used when the patient is still did  not respond to produced matured eggs after clomid medication. The injection is used is lower dose compared with IVF. It increases the chances of successful treatment by stimulating the production of 2 or 3 follicles.

    The cycle will be canceled if more than three mature follicles and will advised the patient to restart  lower doses of hormones because of the increased risk of multiple pregnancies. This risk is, however, much lower with IVF.

Pregnancy Rate (%) (Success Rate)

Overall chance of successful treatment is approximately 10-12 % per cycle.

References

  1. Royal College of Obstetricians and Gynaecologists. Fertility: Assessment and treatment for people with fertility problems – Clinical Guideline [online]. Royal College of Obstetricians and Gynaecologists, 2004 [cited 30 November 2008]. Available from URL:http://www.rcog.org.uk/womens-health/clinical-guidance/fertility-assessment-and-treatment-people-fertility-problems
  2. Ombelet, W. Puttemans, P. Bosmans, E. “Intrauterine insemination: a first step in the algorithm of male subfertility” in Hum Reprod, 1995, 10(Supp 1):90-102
  3. Dastur, A.E. “Artificial Insemination: Historical Review” in Intrauterine Insemination, ed. Gautem Allahbadia, 2005, Taylor and Francis, p 17-21.
  4. Dickey, R. Pyrzak, R Lu, P. et al (1999) “Comparison of the sperm quality necessary for successful intrauterine insemination with World Health Organisation threshold values for normal sperm” in Fertil Steril, 71:684-689.
  5. Cantineau A.E.P. Cohlen B.J. Al-Inany H. Heineman M.J. “Intrauterine insemination versus fallopian tube sperm perfusion for non tubal infertility” in Cochrane Database of Syst Rev, 2004, Issue 3. Art. No.: CD001502.
  6. Hirsch, A. “Male Subfertility [Clinical Review]” in BMJ, 2003, 327:669-672.
  7. Bhattacharya, S. Harrild, K. Mollison, J. “Clomiphene citrate or unstimulated intrauterine insemination compared with expectant management for unexplained fertility: pragmatic, randomised controlled trial” in BMJ, 2008, 337:a716.
  8. Helmerhorst FM, Van Vliet HAAM, Gornas T, Finken MJJ, Grimes DA. Intra-uterine insemination versus timed intercourse for cervical hostility in subfertile couples. Cochrane Database of Syst Rev2005, Issue 4. Art. No.: CD002809
  9. Brody, Steven A., and Robert G. Edwards. Principles and Practice of Assisted Human Reproduction. Philadelphia: W.B. Saunders Company, 1995.
  10. Zhu, Tian, “Intrauterine Insemination”. Embryo Project Encyclopedia (2009-07-22). ISSN: 1940-5030
  11. Laurie Barclay. “Immobilization May Improve Pregnancy Rate After Intrauterine Insemination”. Medscape Medical News. Retrieved October 31, 2009.
  12. Merviel P, Heraud MH, Grenier N, Lourdel E, Sanguinet P, Copin H (November 2008). “Predictive factors for pregnancy after intrauterine insemination (IUI): An analysis of 1038 cycles and a review of the literature”. Fertil. Steril. 93 (1): 79 – 88.

 

Last Reviewed : 15 January 2015
Writer / Translator : Sardiana bt. Sarmidi
Accreditor : Krishnan a/l Kanniah