Intrauterine insemination :- A form of artificial insemination that deposits sperms into the uterus during ovulation . A thin flexible catheter is used to bring washed sperm through the cervix and into the uterus. Fertility medications can be taken for ovulation induction , so that desired number and quality of eggs are released at the time of insemination.
IUI is quick, painless and minimally invasive fertility treatment .
A. (Indication for IUI ) :- it is a common fertility treatment and very often the first procedure that couples will seek .
The IUI involves the following
Step 1. Ovulution Induction with monitoring of the follicle and Endometrial growth.
Ovulution unduction for IUI can be done with.
a). CC alone.
b). CC and inj HMG\inj FSH.
c). Inj FSH\inj HMG ----After a base line scan on a day 2 to ensure endometrial shedding and no residual ovarian cysts , injection of FSH are administered IM daily for selected days depending upon the patient ovarian response . Sometimes we might combine a GnRH agonist or antagonist with the FSH stimulation for enhancing the results and better time of ovulation .
Step 2. Time of Insemination
It is critical since once ovulation takes place the oocyte (egg) is only viable for 12-24hrs.
Sperm washing involves removing the seminal plasma, semen processing is done by various methods. Two of the commonly used processes in our centre are ;
1. Double density technique:- In this method active sperms are collected after filtering the semen through various density gradiants .This method selects morphologically normal sperms and increases the yield of motile sperms.Density gradiants are more efficient in removing debris and dead sperms and gives a cleaner sample.So it is more often used for oligospermia and for samples with lot of debris and dead sperms.
2. Swim – up technique :- In this method after removal of seminal plasma active spermatozoa are allowed to swim up into culture medium with there own inherent motility.Swim-up technique yields highest number of motile sperms.
Various factors affecting success rate of IUI:-
1. Female factors :- Age of the women is the most important determinate of success . success rates decreases after 35 years and falls dramatically after 40 years of age .
2. Ovarian stimulation :- Ovarian stimulation with gonadotrophins results in slightly higher pregnancy rates per IUI cycle as compared with natural cycle IUI and clomiphene IUI . Gonadotrophins enhanced the chances of pregnancy at the expenses of higher multiple pregnancy and the need for need for more frequent monitoring scans .
3. Timing of IUI with USG follicle tracking / monitoring :-Serial USG monitoring of follicle development is essential as the exact timing of IUI is crucial to the success of treatment .
4. Male factor :-Semen parameters :- The count , motility and % of normal morphology are the most important determinant for successful outcome.