IUI or Intrauterine Insemination is the procedure in which washed semen sample is instilled in the uterus around the time of ovulation with the help of a thin catheter in order to improve the chances of conception. It is one of the most commonly used infertility treatment. It is simple treatment done on an OPD basis and does not need admission or anesthesia.

Indications for IUI

IUI is the first line of treatment in many cases. The common indications for IUI are:

• Unexplained Infertility.
• Ovulation disorders (PCOS)-in such patients ovulation induction is done using oral medicines or injections and IUI is performed once eggs are mature.
• Mild male factor infertility- Reduced sperm counts in the male partner.
• Sexual dysfunction in either partner- erectile or ejaculatory dysfunction in male, vaginismus (Painful intercourse).
• IUI with cryopreserved semen sample- If the male partner is not available at the time of ovulation, cryopreserved semen sample can be used for IUI. This can also be used if the sperms have been preserved prophylactically before some treatment (like cancer treatment) that has negatively affected the sperm formation/ count in the male partner.
• IUI with donor semen sample- In cases of azoospermia (complete absence of sperms), a donor semen sample is procured from a licensed sperm bank and used for IUI. The sperm donors are thoroughly screened in order to eliminate the risk of transmission of infectious diseases. The samples are frozen and quarantined for six months. The donor is retested for the presence of infections before the frozen sperms are released from the sperm bank.

Pre-requisites for IUI

• At least one open Fallopian tube.
• Normal to near-normal sperm parameters- in cases of severe defects in sperm parameters, ICSI is the treatment of choice.
• Evidence of growing follicles in the female partner.

The IUI Procedure

IUI can be done in either a natural cycle or stimulated cycle.

1. Natural cycle IUI – in natural cycle IUI, serial follicular monitoring is done and IUI is performed close to the time of ovulation to maximize the chances of fertilization.
2. Stimulated cycle IUI – In a stimulated Cycle IUI, oral medication or injections are given to the female partner to stimulate egg formation. Serial ultrasounds are done to monitor follicular growth. Once optimal growth is achieved, ovulation is triggered with HCG injection and IUI is performed after 36 hours of injection.

On the day of IUI, the male partner is asked to collect the semen sample by masturbation. The semen is then washed and processed and good quality motile sperms are separated. The washing of the semen sample may take 45-60 mins. The washed semen sample is then instilled in the uterus of the female partner. The woman is asked to rest on the table for 10-15 mins after which she is discharged.

The procedure is done on an OPD basis and is usually pain-free.

IUI Success rates

• IUI has a success rate ranging from 15-20% per cycle.
• The maximum chances of conception are usually seen in first 3-4 attempts.
• A critical success factor with IUI is the availability of good andrology facilities at the treating center.
• If a woman does not get pregnant in 3-4 attempts, the case needs to be re-evaluated and advanced forms of treatment (IVF) may be required.