Intrauterine insemination (IUI) - Procedure, Success Rates, Risks and Complications

What is IUI?

IUI, or intrauterine insemination, is an advanced assisted reproductive technique. The infertility specialist implants the active and motile sperm in the female's uterus (womb) in this artificial insemination technique. This fertility treatment is preferred for couples in which the male partner's sperm cannot reach the fallopian tube due to medical conditions. Infertility doctors carry out IUI treatment during ovulation as it enhances the rate of successful fertilization. IUI's success rate is as high as 80% in ideal candidates.

When is IUI Treatment Required?

IUI treatment is advised in the following cases:

• Low Sperm Count - Ideally, the sperm counted should remain more than 10 million after washing the sperm
• Lowered Sperm Motility - When sperm is not motile enough, it fails to reach the fallopian tube where it meets the female egg or ovum. 
• Ejaculatory Problem - For males who deal with ejaculation dysfunction, IUI helps them successfully conceive.
• Hostile Mucus of Cervix - Usually, a sperm stays for some time in the cervical mucus. A woman's cervix is highly acidic and can affect sperm's pH and ultimately destroy it.

However, IUI is unsuitable in cases where males have severe infertility, or the female has blocked fallopian tubes, pelvic infections, or endometriosis.

Pre-treatment Preparation

Consultation with the doctor: Along with your partner, ensure a detailed in-person discussion with the infertility specialist about the intricacies of the IUI treatment and your expectations. Also, talk about your medical history and any ongoing medication you or your partner may take. This will help your IUI specialist understand your case clearly, without missing any crucial detail.

Diagnosis:

To understand the root cause of the problem, doctors recommend diagnostic tests for both partners. 

Tests For Males Before the IUI Procedure

• Semen Analysis: There can be numerous issues related to the male sperm. To find the exact condition, the infertility specialist collects the sperm sample and sends it to the lab for examination.
• Imaging Tests: In most cases, the male partner is asked to undergo screening tests like ultrasound or MRI of the genital region to assess any underlying abnormality. 

• Testicular Biopsy: Doctors recommend examining a patch of testicular tissues to check for any abnormalities in the male reproductive tract that may lead to infertility issues. In case, the doctor finds any issue; the couple is advised to use a donor's sperm.
• Hormonal Test: Hormone testing is carried out to check the testosterone level and other male hormones in the body.
• Genetic Test: This test is conducted to check if there is any genetic disorder or defect in the male genitalia that can cause infertility

Tests for Females Before the IUI Procedure

• Ovulation Test: This test is done by checking the female's blood sample to know if she is ovulating or not.
• Imaging Tests: Pelvic ultrasound or MRI helps in detecting if there is any disorder or defect in the ovaries and the uterus. 
• Testing For Ovarian Reserve: IUI specialist requires checking the egg reservoir in the ovaries to evaluate the number of eggs available for ovulation. This is done through a hormonal test when the female's menstrual cycle begins. If there is some underlying issue with the ovarian reserve, the doctor recommends an alternative mode of treatment. 

Day Before IUI Treatment

As IUI is a non-surgical procedure, the patient is not needed to get admitted a day before or remain hospitalized overnight on the day of IUI treatment. However, feeling a little anxious a day before the treatment is standard. Thus, it is necessary to relax and try to stay calm. Talk to your near ones about your concerns, have light and balanced meals, and stay hydrated. Rest well to ensure you are well-prepared to visit the IUI treatment center.

Procedure

The entire IUI treatment takes multiple sessions to complete. The whole treatment is broken down into the following steps or phases:

• Counseling With the Doctor: IUI is a complex process that can be challenging when not properly discussed thoroughly with the doctor. The counseling or detailed discussion is followed by creating a treatment plan.
• Ovarian Stimulation: The IUI specialist gives oral medication that stimulates the ovaries and then carefully observes the process and speed of egg production in the ovaries. Usually, the course of oral medicines is for 8-12 days based on how the female's body responds. Alternatively, ovarian stimulation can be done through injections administered in reasonably fatty body parts, like the stomach
• Ovarian Monitoring: The doctor monitors follicle development once the ovaries are stimulated enough. During this stage, hormone tests and ultrasounds help assess the ovarian follicles' growth. Keeping track of ovulation allows the doctors to confirm the best dates to begin the IUI treatment to attain the desired results.
• Ovarian Trigger: When the ovarian follicles develop and attain a specific shape and size, the doctor injects hCG (human chorionic gonadotropin) that triggers ovulation. Usually, ovulation takes place 36 hours after receiving the trigger shot.
• Sperm Harvesting: The IUI specialist and the couple decide unanimously whether they should use frozen sperm or a fresh specimen. In cases fresh sperm is required, the male partner can submit it at the infertility center by masturbating. If the couple decides to use frozen sperm, they need to get the sperm defrosted and washed.
• Sperm Insertion: As the female ovulates, the doctor asks her to visit the treatment center for the insertion of sperm. The doctor uses a thin, flexible catheter to insert sperm into the female's uterus. The female may experience only mild cramps and discomfort when the doctor inserts the catheter. However, unlike IVF, IUI does not involve multiple painful steps.
• Pregnancy Test: A Pregnancy Test is the final step of the IUI treatment, where the IUI specialist checks if the female partner has successfully conceived. The pregnancy can be done 14 days following sperm insertion. If unsuccessful, the doctor may need to repeat the entire IUI treatment.

Post-Procedure

Your infertility doctor will tell you what steps to follow to increase the chances of pregnancy. The general precautions to take after IUI treatment include:

Do's:

• Rest for a few hours at the treatment center right after sperm insertion. Even when you return home after the procedure, it is highly advised to rest completely for a few days. 
• Maintain a balanced healthy diet to increase the chances of fertilization. Nourishing the body is crucial to ensure IUI success. Consume more foods enriched with Vitamin D as recommended by your doctor.
• Avoid stress and anxiety, as stress hormones can affect the fertilization process.
• Indulge in light exercise a few days following the IUI treatment, only after consulting your IUI specialist. Light physical activity boosts blood circulation to the uterus and the entire reproductive tract.

Don'ts:

• Take painkillers without consulting the doctor as these can reduce the chances of IUI success
• Lift heavy objects that can pressurize the lower abdomen and result in cramps and bleeding after IUI treatment
• Expose yourself to hazardous radiation and work closely with high radiation machines and chemicals
• Indulge in drinking, smoking, or substance abuse as these can cause infertility and high-risk pregnancy

IUI Failure Symptoms

Immediately contact your infertility specialist if you experience any IUI failure symptoms. If IUI fails, it results in abnormal vaginal bleeding, heavy menstrual bleeding, and abdominal cramps. It is of utmost importance to contact your doctor and undergo proper tests in such a scenario. Such complications can be avoided to a great extent by religiously following all the instructions that the doctor gives.

IUI success symptoms 

Following are the signs of successful pregnancy after IUI treatment:

• Delay in the menstrual cycle
• Implantation bleeding
• Sore breasts
• Nausea and fatigue
• A slight higher body temperature
• Cravings and mood swings

Risks and Complications

Generally, the IUI procedure is safe fertility that only certified specialists perform. However, like any other medical treatment, there are a few risks and complications related to the IUI procedure that depend upon the doctor's expertise and the patient's overall health conditions.

During the Procedure:

• Scarring of cervix or uterus
• Damage to blood vessels
• Spotting or bleeding

After the Procedure:

• Risk of becoming pregnant with multiples
• Ovarian hyperstimulation syndrome causes inflammation in the ovaries
• Acute abdominal pain