When you are recommended for the first time any fertility treatment, it sounds confusing and not conclusive. Or JUST weird. And you are mentally entrapped into all those medical abbreviations without any thought what you should start with…Embarrassed, frustrated, and lost, you cannot choose what treatment option you should start with because you JUST don’t know what you are involving yourself in… You feel yourself like a bundle of nerves but you shouldn’t! We are here to navigate you in this complex Ecosystem!
If you are not sure should you CHOOSE IVF treatment, or ICSI treatment, or IUI treatment, or something else, IT IS ESSENTIAL to ‘GLIMPSE’ through the basic information about all these treatments, to analyze their BENEFITS, COMPLICATIONS, and RISKS. And only after that to CONSULT with the doctor and to choose the one. If your doctor has already recommended you to start with Intrauterine Insemination, then this article is designed for you!
Envisioned or not but the first document entitled “Intrauterine insemination” was published in 1962! So long time ago! Since that timeline, Intrauterine Insemination’s technique became more advanced and more sophisticated. The innovations that were designed for this technique and are used today include sperm preparation, monitoring for preovulatory timing, and ovulation induction.
(1) What is Intrauterine Insemination?
Intrauterine insemination is the non–invasive procedure where sperm are washed (to remove dead sperm and proteins), concentrated (to increase the volume of the viable sperm), and placed in a woman’s uterus via catheter (a very small tube that is passed up the cervix and into the uterus) around the most optimal time of ovulation. This procedure is done as close to the time of ovulation as possible. The Reproductive Specialist may recommend you Intrauterine insemination with ovarian stimulation or without ovarian. The mode of IUI insemination also varies as the sperm suspension can be deposited in the cervix, the uterus, the peritoneum or the Fallopian tube.
(2) What is generally accepted about Intrauterine insemination?
It is generally accepted that intrauterine insemination should be preferred to more invasive and expensive techniques of assisted reproduction. That is why IUI is one of the first assisted reproductive technologies typically recommended by the doctors (reproductive endocrinologists). IUI is proven easier to perform, less invasive and less expensive than other methods of assisted reproduction.
(3) When should the Intrauterine insemination treatment be recommended as the fertility treatment?
It is proposed as a first–choice treatment in cases of unexplained and moderate male factor subfertility (when the male partner is experiencing low sperm count, decreased sperm motility, or decreased sperm viability), Endometriosis, Polycystic Ovarian Syndrome, cervical mucus issues, for most cases of non–tubal infertility, unexplained infertility (with potential male factor), combined male subfertility and ovulatory dysfunction, and immunologic causes.
(4) In which cases Intrauterine insemination is not only recommended but effective treatment?
Cervical factor subfertility
Bypassing the hostile cervix, it increases the probability of conception because the sperm is INJECTED directly into the uterus.
IUI is effective only when controlled ovarian hyperstimulation (COH) is used.
Male factor infertility
IUI in natural cycles should be the treatment of choice in case of male subfertility, providing an inseminating motile count (IMC) of more than 1 million can be obtained after sperm preparation and in the absence of a triple sperm defect.
(5) In which cases IUI is forbidden to be used?
Surely, there are several contraindications for this treatment option. IUI is contraindicated in women with a blocked or damaged Fallopian tube, cervical atresia, cervicitis, endometritis or bilateral tubal obstruction and in most cases of amenorrhea or severe oligospermia.
(6) What Benefits Does IUI Have?
(I) Washing procedures enhance sperm quality
The washing procedures clinicians perform to remove prostaglandins, infectious agents, antigenic proteins, non–motile spermatozoa, leucocytes, and immature germ cells. As a result, sperm quality increases. This may also enhance sperm quality by decreasing the formation of free oxygen radicals after sperm preparation.
(II) Natural (unmedicated) cycle IUI is possible to perform
With IUI you have options with medications. You can do a natural cycle (no medications), with Clomid (a pill to stimulate follicles) or with low stimulation medications. Natural cycle IUI and minimal dose regimen with gonadotrophins are valuable options to prevent the unacceptable high multiple gestation rates described after ovarian hyperstimulation.
(III) Less invasive method: more physiological
Intrauterine insemination is the procedure where sperm are washed (to remove dead sperm and proteins), concentrated (to increase the volume of the viable sperm), and placed in a woman’s uterus via a catheter (a very small tube that is passed up the cervix and into the uterus). You don’t have the oocyte retrieval [surgical procedure which is performed under the anesthesiology on the operating table] as you do with IVF.
(IV) Reduced psychological burden
After the oocyte retrieval [the whole procedure only takes about 15 minutes, so you wake up about 20–30 minutes later in recovery], at first you don’t feel any pain because they give you some good pain medications through the IV, but once those wear off the pain is terrible. Apparently, the amount of pain a woman feels after oocyte retrieval depends entirely on pain tolerance and the number of oocytes retrieved.
(V) The procedure is performed under the transvaginal ultrasound guidance
The IUI is performed under an internal ultrasound [a transvaginal ultrasound] and as soon as the technician performed an external ultrasound, a tiny catheter is inserted into cervix. Using the ultrasound screen as the guide, the doctor pushes the catheter through the cervical canal and points it toward the top of the uterus and right or left Fallopian tube (the side with the mature follicle). Ultimately, the doctor injects the sperm through the catheter and into the uterus. The IUI may be performed also without ultrasound visualizing. The technique is the same: a tiny catheter is placed inside and the sperm is transferred via that tiny catheter inside uterus. IUI procedure usually is usually completed within a few minutes!
(VI) The timing of the procedure performance is surprisingly short
The process lasts only about 60 to 90 seconds. After that, you will be advised to stay seated for a few minutes.
(VII) Less expensive treatment option
In comparison with IVF and ICSI, Intrauterine Insemination is less expensive fertility treatment option. The whole IUI treatment cycle cost around $2,000–$4,000 including medications where the average IVF treatment cycle costs around $10,000–$36,000. So, you can get a few IUI treatment cycles in for the rate of 1 IVF treatment cycle.
(VIII) Low risk for ovarian hyperstimulation syndrome (OHSS)
Ovarian hyperstimulation syndrome (OHSS) occurs in 1%–10% of women undergoing ovarian hyperstimulation with exogenous gonadotrophin administration and is a recognized and potentially life–threatening complication. Ovarian hyperstimulation syndrome (OHSS) may complicate all methods of treatment in which gonadotrophins are used; however, OHSS seems to be rare after controlled ovarian hyperstimulation–IUI (COH–IUI) compared with IVF due to the fact that lower dose stimulation protocols are more often used.
(IX) Low risk of thromboembolism
Deep venous thrombosis (blood clots) has been reported extensively following ovarian hyperstimulation syndrome during in–vitro fertilization (IVF) treatment cycles. The thromboembolic event is dangerous because it is a prominent cause of maternal deaths. It is also unpredictable because there is no clinical marker to reveal it early. The site of the thromboses, the timing of thromboses relative to oocyte retrieval, and possible predisposing factors are hard to diagnose.
(X) More effective than Intracervical Insemination (ICI)
If you are proposed ICI, you should know that IUI is more effective. Wondering why? ICI involves placing the sperm into the cervix. Once placed in the cervix, the sperm then make their way to the uterus where they can fertilize the oocyte, mimicking the action of natural fertilization. IUI involves placing the sperm directly inside the uterus. Because this technique bypasses the cervix and does not rely on the sperm traveling to the uterus themselves, the chances of fertilization are increased.
(7) What side effects does IUI have?
(I) Most women experience little to no pain during the IUI procedure.
(II) Some women may experience mild cramping with IUI procedure.
(III) Severe side effects, like infections, can occur following IUI, but these are very rare.
(IV) Most Intrauterine Insemination side effects are caused by the fertility drugs taken during the IUI cycle, not the IUI procedure itself. When you begin an Intrauterine Insemination cycle, your doctor may prescribe you fertility medications to increase your chances of IUI success. These drugs will stimulate your ovaries to produce multiple oocytes for the insemination. These medications have the side effects: Mood swings, Depression, Hot flashes, Breast tenderness, Nausea, Bloating, Headaches or visual disturbances, Swelling or a rash around the injection site (if you are given the injections), Swollen and painful ovaries, signaling ovarian hyperstimulation syndrome (OHSS), Pelvic discomfort, Ovarian cysts. IUI side effects caused by fertility drugs should disappear once the medication is stopped. Always call your doctor if any uncomfortable symptoms develop during an IUI cycle.
(8) Is there the risk of conceiving multiples?
Dreaming about having twins or triplet? The risk of conceiving multiples (becoming pregnant with twins, triplets, or even more) with IUI without ovarian stimulation is very small but sometimes it happens. IUI without ovarian stimulation can be assumed as a natural conception, and as you know sometimes it is possible to get pregnant with more than one tiny one! But if you start IUI treatment with ovarian stimulation, you may conceive the multiples because of taking fertility drugs.
(9) What are IUI medical procedures and insemination methods?
The first appointments with the Reproductive Endocrinologist will be unbelievably overwhelming. They will be inspiring, ‘glowing’ and even thrilling. So many wonderful options and you have the choice. Surely, there are so many various treatment options and treatment protocols. Some of them are even FLEXIBLE! You will DISCUSS everything with your doctor, including medications you need and listed further testing to undergo.
BUT there is still ONE BUT. Any infertility treatment option starts with Testing and Screening. After fertility testing and screening your doctor will suggest you the treatment options. If your doctor has already discussed with you all the options, and you chose IUI, then you should expect the following things.
Prior to IUI procedure, they will remove seminal plasma to avoid prostaglandin–induced uterine contractions. If seminal plasma is not removed, then uterine contractions can make the procedure not only painful but complicated and ineffective. Moreover, insemination with unprocessed semen can cause a pelvic infection. Removal of the seminal plasma can be achieved by relatively simple procedures. The most frequently used methods involve centrifuging spermatozoa through culture medium or density gradients followed by resuspension in suitable culture media.
Quality of the specimen
There is no consensus on a lower limit of semen quality. The experts define lower limits differently, as sperm concentration per milliliter, or as the total number of motile spermatozoa in the semen sample, or as a total number of motile spermatozoa in the sample for insemination. But here it should be noted that if the semen sample contains <10 million sperm in total the chances to conceive the tiny one is lower.
Mode of insemination procedure
During IUI procedure the sperm suspension can be deposited in the cervix, the uterus, the peritoneum or the Fallopian tube. IUI is by far the most common method. It is performed by introducing a 0.2–0.5 ml sperm suspension into the uterus with a tiny catheter, usually without ultrasound–imaging guidance.
With Fallopian tube sperm perfusion (FSP), the sperm volume usually taken for insemination is 4 ml, so that with this large volume of fluid the inseminate may fill not only the uterine cavity and Fallopian tubes. With Fallopian tube sperm perfusion some of the sperm volume may even end up inside the peritoneal cavity.
Sometimes IUI procedure is done using the frozen semen samples. Here it is vital to underline that for frozen semen samples, IUI is better than intracervical insemination (ICI).
The timing of the insemination procedure
Correct time–scheduling of IUI is essential, because of the limited time interval in which spermatozoa can retain their capability to fertilize the oocyte and survive in the female reproductive tract for approximately 3 days after ejaculation, while oocytes remain fertilizable only for 12–16 hours after ovulation.
In the case of IUI, spermatozoa are processed, devoid of seminal plasma and only the fraction of selected. After that, motile spermatozoa is transferred via a tiny catheter directly into the uterine cavity. Considering these facts, the time frame within which a successful conception after IUI procedure is possible is shorter than in the setting of natural conception cycle. Therefore, the procedure should ideally be scheduled as closely to the time of ovulation as possible to increase the possibilities of successful oocyte’s fertilization.
IUI can be done one time or several times. Insemination can be done at various time points around ovulation. If it is done without ovarian stimulation with fertility drugs, then the ovulation timing is closely monitored by the internal ultrasound. If ovarian stimulation is necessary for IUI procedure, then the most optimal time for the insemination is 32–36 hours following hCG administration.
(10) Sometimes they recommend the insemination using the donor sperm
Artificial insemination with donor sperm (AID) may be performed for medical reasons. The medical reasons include: (1) obstructive and non–obstructive azoospermia, (2) severely impaired semen quality in couples who do not want to undergo or were not successful with ICSI, (3) severe rhesus isoimmunization, (4) prevention of vertical transmission of a genetic defect. Insemination with donor sperm is also the great treatment option that allows to build LGBT families (to assist lesbian couples) or to make the dreams of single women to achieve pregnancy come true.
Something to say in conclusion?
As the conclusion note, it should be underlined that Intrauterine insemination without controlled ovarian stimulation or Intrauterine insemination with controlled ovarian stimulation is frequently used in couples with unexplained infertility. If there is an increased risk of conceiving multiples, your doctor may recommend you to start Intrauterine insemination cycle without controlled ovarian stimulation (COS) as COS is closely associated with an increased risk of multiple pregnancies and ovarian hyperstimulation syndrome (OHSS). IUI cycle without controlled ovarian stimulation should be assumed as the most natural designed treatment option.
The most essential thing your doctor should closely monitor is the time frame for scheduling the IUI. Time framing is of vital importance for eventual oocyte’s fertilization and thus pregnancy.
This technique is a wonderful treatment option for the couples diagnosed with unexplained subfertility, mild endometriosis or mild male factor infertility. It can be also the most sophisticated solution for those couples who have social, cultural or religious objections to In Vitro Fertilization (IVF).
Surely you have already envisioned in your mind the first ‘DATE’ with your small bundle of joy as the moment of cordial connection. But have you ever envisioned how your future baby may look like? Have you ever mentally ‘glanced’ at your future baby’s gorgeous eyes? Have you ever thought that those intriguing gorgeously–shaped dark–golden curls fall around your future baby–girl’s back and shoulders? The gorgeous baby–girl with the cascade of dark–golden curls down to her waist, so intriguingly curled, so glittering, so gorgeous, so tempting… And you are captured by the divine beauty of her curls… Your girl is basically so attractive, that even you wonder if she is for real. She is impeccably charming. Or if you have a tiny dude, have you ever envisioned him with so impeccably charming? With so sparkling dark eyes? With so cute tiny curls? Dreaming?Wondering if that possible? Be sure, everything is possible! The Advanced and Sophisticated OptionsWill TurnYour Dream into Reality!
Wondering what every option noted in this list means? Worrying about the advantages and disadvantages it has? Not sure that this option is designed for you? Feeling like a bundle of nerves because you have no idea what option should be chosen because there are several ones that may be proposed for you? No worries here! We will navigate you in this Complex Ecosystem and will show you what is “inside” every treatment option! Why Waiting? All the Options are at your Fingertips! Just Bundle Up and Glance Through!
OVU.com: Connecting Clinics with Patients! Connecting Patients with Clinics! Connecting the World of the Most Powerful and Trusted Clinics with the World of Patients in One Safe, Exclusively Designed Environment! The Miracles start here… All the Treatment Options Are at Your Fingertips! OVU.com