Ultimate guide to understand the IUI procedure

Intrauterine insemination (IUI) is a commonly used fertility treatment.
In an IUI procedure a doctor will take a processed semen sample containing washed, prepared sperm and place it in a woman’s cervix into the uterine cavity at the time of her ovulation. After they are in the right place at the optimal time, the egg will travel down the fallopian tube.

Who does an IUI procedure help?

If a couple struggles to conceive because of the following:
• When the couple does not conceive after medication and timed intercourse
• They can’t conceive because of a physical problem such as retrograde or premature ejaculation.
• If the male husband has HIV, then the processing of his semen sample before insemination lowers the risk of passing the disease.
• Also helps couples who have fertility struggles, such as mild endometriosis, mild male-factor infertility such as low-sperm count or motility.

For an IUI procedure to have optimum impact, the woman’s fallopian tubes must be open and healthy. This can be determined by undergoing a tubal patency test. With the help of a laparoscopy, problems or blockages in the uterus or fallopian tubes can be located.
In the case of tubal blocks or the presence of adhesions, an IUI procedure is not recommended. This is because the egg might not be able to travel from the ovary to the uterus. If there’s one working tube and ovary, an IUI procedure is still possible.

How is an IUI procedure done?

At the beginning of the procedure, the use of fertility medicines is determined, depending on the patient’s infertility diagnosis. Some patients may need to use fertility medicines alongside their IUI procedure. These medicines are essentially to stimulate and increase the ovulation cycle in the woman. Some instances don’t require drugs for stimulation and a natural cycle is sufficient.

However, in some instances the risk of multiple pregnancies increases when taking fertility drugs. Sometimes if the requirement for fertility drugs is great then an IVF treatment is recommended as it allows for more control through the procedure and multiple pregnancy rates can be lower. Multiple pregnancies have also been connected to an increase in the risk of miscarriage or other complications.

During those cycles with no stimulation, the IUI procedure is timed to take place during the time of natural ovulation. The doctor will continuously monitor and track the cycle using blood tests and scans. The ideal window of an IUI procedure to take place is between the 12th and 16th day of the menstrual cycle. The exact time period can defer, depending on the individual cycle. An IUI procedure is also recommended during stimulated ovulation by the fertility expert. During which the patient is given fertility drugs just before the beginning of the menstrual cycle. This helps stimulate the ovaries to develop several mature eggs for fertilisation.

Experts then conduct an ultrasound scan to locate the egg and check its maturity levels. A person can ovulate naturally, or be given a hormonal injection to cause the occurrence. A healthy sperm with good motility is extracted then inserted into the uterus between 24 hours and 40 hours of the hormonal injection.
This is carried out using a catheter through the cervix, after which the doctor will then place the sperm directly into the uterus near a fallopian tube. This is the optimal placement for an egg to travel from an ovary to the uterus.

The success rate of an IUI procedure is dependent on the cause, severity of the diagnosis and the patient’s age.

What is the success rate of IUI in India?

IUI or Intra Uterine Insemination is a procedure where the woman is given medication in order to increase the number of mature eggs and then inseminated with healthy sperms.IUI is usually carried out close to the time of ovulation to increase the chances of fertilisation.

It is among the most widely used practices to treat infertility across the globe.

If your doctor has recommended you undergo Intra Uterine Insemination, it is important that you learn more about this procedure.

What is the IUI success rate in India ?

It is important to note that IUI success rate in India is generally lower than the success of IVF (in vitro fertilisation). A good IVF clinic would have a success rate of one third (1/3^rd) to half the rate (1/2). Many a times a good fertility clinic would try just one cycle of IUI, and if it doesn’t result in a positive pregnancy, they may ask you to consider undergoing IVF as the next step.

How is IUI performed?

We start the IUI cycle by stimulating the female and giving her medications to increase the number of eggs. By doing so, we increase the chances of conception. We perform an IUI before the egg is released or a pre-ovulatory IUI.

Once your menses start, you will have to call up the reception to book an appointment for the next day i.e. your Day2.

On Day 2/Day 3 you will be having an ultrasound and some blood tests. Some medications may also be started from the same/next day. Your partner may or may not accompany you on this day.

Once you start your medicines, the doctor needs to check the growth of follicles from the 7th/8th day.

From the 8th day onwards, you will be advised to visit the doctor every alternate day to check the growth of follicles. We would request you to take out time for the same.

The growth of follicles varies from one individual to another. The follicle may be ready by Day 8 or may be by Day23 as well. Hence we request you to take it easy. Approximately, by 11th/12th day, the follicles may be ready.

Once declared as ready, we ask the patients to go for a urine test at the clinic to confirm the maturity of eggs. We perform this by using an LH kit and get the result in 15 mins.

After this we plan the trigger. Trigger is an injection which ensures that the egg would get released after 36 hours. As we perform the IUI before the egg is released, we schedule the IUI within 24 hrs of the trigger. There may be variations to this as well.

On the day of IUI your partner has to give his semen sample for processing and insemination takes place approximately after one and a half hours.

You may be called for a follicle rupture monitoring ultrasound the next day to confirm ovulation. If there is still no ovulation, we repeat the IUI.

You have to report next, after 15 days. By 15 days we mean 15 days after IUI (second if applicable) excluding the day of IUI. Hence, a lot of the time to treat less complex cases of infertility, IUI is usually recommended.