Step by step guide for IUI treatment
- Live birth rates per IUI cycles are between 5 to 15%
- In IUI sperm is washed and placed directly into the uterus of a woman
- IUI is a non-invasive and fast method of treatment
You have stumbled upon this page mostly because you are trying to decide whether Intrauterine Insemination (IUI) is the right treatment for you. And if that is true, do not worry we are here to help and guide you with everything you need to know about IUI. Intrauterine insemination (IUI) is a form of artificial insemination which is used for the treatment of infertility. The sperm from the male partner is washed and concentrated in the laboratory. After this, it is placed or implanted directly in the uterus of the women. This is done around the time when the ovaries release the egg to be fertilized.
In this article
What is IUI?
Intrauterine Insemination (IUI) is a relatively simple and inexpensive fertility treatment when compared to IVF. IUI is also known as alternative insemination, artificial insemination, or donor insemination. In IUI, the sperm cells are directly placed into the patient’s uterus around the time of their ovulation. This helps the sperm get closer to the egg. It also cuts down the distance and time the sperm has to travel, meaning it makes it easier to fertilize the egg. The IUI procedure may or may not require consuming fertility medication for stimulating ovulation. Semen from the partner or donor is collected and then it undergoes “sperm washing”. In sperm washing, a concentrated amount of healthy sperm is collected from the semen. Then the healthy and concentrated sperm is implanted into your uterus. The patient may or may not conceive after this process depending on whether the sperm fertilizes the egg. If fertilization takes place, the fertilized egg gets implanted in the lining of your uterus.
IUI is known for its low-tech and simple procedure, and also because it can be less expensive when compared to other methods of fertility treatments. IUI increases the chances of pregnancy. As everybody’s body is different there is no guarantee that IUI will work.
How is IUI better than timed intercourse?
A woman is fertile for approximately five days before she ovulates until 24 hours after ovulation during each monthly cycle. These 6 days are known as the ovulation window. The ovulation window is the limited survival time of the egg and sperm. This 6-day window in the menstrual cycle when the chances of pregnancy are the highest. Therefore, a guided timing of intercourse that coincides with the ovulation window may improve conception rates.
A typical cycle of IUI consists of the use of fertility medications for stimulating the growth of eggs, inducing ovulation, and preparing the uterine lining for implantation of the embryo. The procedure also involves semen washing and concentration. In most cases, IUI is prescribed as the first treatment option for unexplained fertility, after timed intercourse has failed. IUI has been proven to offer couples with male subfertility benefits over timed intercourse. IUI increases the chances of conception as it uses highly concentrated and morphologically mobile, active, and normal sperm, which is directly placed into the uterus at the time of ovulation. It also substantially increases the chances of conception by putting millions of sperm at the top of the uterus. The more the amount of sperm in the uterus the more sperm in the tube, which means there will be higher odds of conception and birth.
Who needs IUI?
If you are still wondering if Intrauterine Insemination (IUI) is the right treatment for you, do not worry. Here is a list of situations in which you may require IUI:
- Women who may not ovulate or have ovulatory dysfunctions. For eg. hypothalamic patients or those with PCOS
- Women with unexplained infertility
- Women with mild Endometriosis-related infertility
- Women whose male partners have minor semen abnormalities or ejaculatory dysfunction (Male infertility)
- Women whose male partners have frozen their sperm due to any reason.
- Women who may need donor sperm. For eg. LGBT couples, or heterosexual couples who struggle with male factor, or even a single woman looking to have a baby
- Women with hostile cervical mucus
- Women whose male partners have unexplained infertility
- Women who have undergone treatment with fertility drugs alone and were not successful
- Women who face sexual pain which makes intercourse impossible
- Women with Semen allergy
IUI is not recommended for:
- Women with blocked fallopian tubes
- Women with severe endometriosis
- Women with previous pelvic infection
What are the types of IUI?
The different types of IUI cycles are:
The Natural cycle
In a natural cycle of IUI, the woman is not required to take any drugs for stimulating the ovaries for egg production. Here, the woman can naturally grow follicles and ovulate. Age is a vital factor that can affect the outcome of stimulated or unstimulated IUI. The woman’s menstrual cycle is monitored for determining the time of the insemination. Once the day is finalized, semen from the male partner is collected. Semen from the partner or donor then undergoes “sperm washing”. In sperm washing, a concentrated amount of healthy sperm is collected from the semen. Then the healthy and concentrated sperm is implanted into your uterus. The patient may or may not conceive after this process depending on whether the sperm fertilizes the egg. If fertilization takes place, the fertilized egg gets implanted in the lining of your uterus. The main goal here is to get the sperm to the right place for fertilization during the ovulation window.
The Trigger cycle
A trigger IUI Cycle is slightly different from a natural cycle of IUI. Here, medication is used to trigger ovulation. The doctor monitors the follicles via ultrasound as the patient is approaching ovulation or in the middle of the menstrual cycle. Medication generally is known as a trigger shot is used when the uterine lining is at least 7mm and the follicle is at least 20mm for triggering ovulation in women. The trigger shot is an injection that is given in the abdomen. The insemination procedure is generally scheduled 24-36 hours after the trigger medication is given. The doctor may also suggest taking progesterone supplements for helping with implantation. These shots are mostly used in both injectable medication IUI cycles and oral medication IUI cycles. Since trigger shots contain hCG, you may get a positive on a pregnancy test without even being pregnant, if you test too early after the shot.
Oral Med cycle
Oral Med Cycle in IUI involves:
Anovulatory Patients: These patients can start their medication at any time. But in case the patient’s uterine lining is abnormally thick at baseline an exception is made. This is because it might be an indication of a problem with the uterus. In this case, progesterone is given for at least 7 to 10 days to cause the onset of a period. Clomid or Letrozole (oral medicines) may be started thereafter.
Unexplained Patients: These patients can start their medication on day 3 or 5 of their cycle. With the help of an ultrasound, the doctor will check and see that no follicles have already started the process of growing. This is because once one follicle starts growing, it is not likely that other follicles will start growing in response to letrozole or Clomid. The doctor also checks for estrogen levels with the help of blood work for confirming this.
Once the patient has started taking the oral medicines, they continue it for 5 days. 4 days after starting the medicines the doctor observes if any follicles are growing and records how big they are. After this, the doctor either increases the dose if no follicles seem to grow or switch to gonadotropins if follicles are not growing and the maximum dose for Clomid or letrozole is reached. The doctor may also cancel the cycle if too many follicles are growing. In some cases, the doctor may recommend continuing waiting if the cycle seems promising to them. Some patients may be resistant to letrozole or Clomid. In such cases, doctors may add medications such as dexamethasone or metformin for helping ovulation.
Injectable Med cycle
Injectable gonadotropin medications may also be used in some cases for IUI procedures. An injectable IUI cycle is typically recommended after having previously failed IUI/IUIs as improved pregnancy rates were observed with the administration of hCG after IUI. These injectable medicines help in stimulating the ovaries for follicular development and they also improve the odds of pregnancy. The increased odds of pregnancy comes with the risk of increased chances of multiples.
Injectable med IUI cycles must be managed carefully with the help of ultrasound and blood work monitoring to make sure that too many follicles do not develop. Even though it is relatively uncommon, cycle cancellation or cycle getting converted to IVF is possible when injectable medications are used. This type of IUI is considerably more expensive when compared to those with Clomid. This is because the fertility drugs are highly-priced and also there is a constant need for monitoring with ultrasounds and blood work in this procedure.
Artificial insemination can also be classified into:
It is one of the easiest and least costly forms of artificial insemination as it closely mimics intercourse. In this procedure, semen is introduced to the cervix opening with a needleless syringe. After the sperm is inside your body, you may need to wear a conception cap for some hours. The cap helps in holding the semen inside the body, which raises the chances of successful implantation.
The IUI procedure may or may not require consuming fertility medication for stimulating ovulation. Semen from the partner or donor is collected and then it undergoes a “sperm washing”. In sperm washing, a concentrated amount of healthy sperm is collected from the semen. Then the healthy and concentrated sperm is implanted into your uterus. The patient may or may not conceive after this process depending on whether the sperm fertilizes the egg. If fertilization takes place, the fertilized egg gets implanted in the lining of your uterus.
Intrauterine Tuboperitoneal Insemination
Intrauterine Tuboperitoneal Insemination is similar to IUI except here, the sperm is injected into the fallopian tubes as well. Once the semen is put into the body, a clamp is placed on the cervix to prevent semen leakage. This is a great fit for couples with mild endometriosis or mild male infertility because it bypasses the affected organs. Fertility drugs may or may not be used in this procedure depending on the patient’s egg-producing capacity.
In this type of insemination, sperm is placed only in the fallopian tubes. It is also known as fallopian tube sperm perfusion. Sperm is placed directly into the fallopian tubes with a catheter that goes through the cervix and the uterus.
What is the IUI process?
An IUI cycle often includes taking medication for stimulating the ovaries to produce eggs, then with the help of a simple technique the washed sperm is injected into the uterus. We are going to take you through the entire process so you know what to expect.
Day 1 of cycle
In anovulatory patients, the medications can start at any time as ovulation does not take place or is irregular. However, if the patient has a thick uterine lining at the base, she will have to take a 7-10-day course of progesterone which will cause the onset of a period.
Day 2-12 of cycle
In the first phase of IUI, the development of the follicles, egg, and uterine lining takes place. This can take place with or without the use of fertility medications. In most cases, drugs are used as it helps in the development of eggs and increases the chances of pregnancy, and thus the chances of live birth. Fertility medications are started on day 2-4 of the menstrual cycle after the doctor confirms that the uterine baseline is at the right measurement. Oral medicines like letrozole are usually taken for 5 days and gonadotropins are usually taken for about 10 days. This phase of IUI mostly involves blood work and ultrasound monitoring as it helps in determining the follicular and lining growth. It also helps in adjusting medications if necessary, ensures that the cycle is safe, and is conducted in a calculated way.
Day 13 of cycle
The second phase of the IUI procedure involves determining the ovulation period. We have made it clear by now that IUI is performed as close to the day of ovulation as possible. For this, it is important to determine the ovulation day. This can be best done with the help of a few blood tests and ultrasound which helps in measuring luteinizing hormone (LH). When LH and follicle size looks good a trigger shot is administered (not in all cases). If the patient is anovulatory, a trigger shot is necessary. Alternatively, ovulation can also be measured with an ovulation predictor kit (not as accurately). The insemination procedure is scheduled 24-36 hours after the trigger shot is administered or a positive test on the ovulation predictor kit.
Day 14 of cycle
On the day or before a day of the insemination procedure, sperm is collected from the male partner (not the case when frozen sperm or donor sperm is used). The sperm is then washed and cleaned and a concentration of active sperm is separated and stored in the labs.
Day 14 of cycle
The last phase of the IUI procedure is when the actual insemination takes place. During the procedure, the doctor slides a catheter which is filled with concentrated motile sperm into the uterus. The uterine cavity is injected with the sperm and the catheter is removed. It is a simple and painless procedure that doesn’t take more than a few minutes and it does not even require anesthesia. Usually, there is no discomfort after the procedure except for some mild cramping. It is okay to get up shortly after the procedure and it does not impact the chances of conception. In some cases, insemination for two days in a row will be recommended, but mostly a single well-timed insemination in one menstrual cycle is enough.
How to prepare for IUI?
Before starting the procedure, the patients generally undergo a series of tests to ensure IUI is the right step for them. This helps the doctor in understanding the patient’s fertility needs better. Blood work is done to test for hormones that regulate ovarian reserve, and genetic testing is also done to make sure that the patient is not a carrier for the disease.
A hysterosalpingogram (HSG) is also taken which helps in ensuring that the fallopian tubes are open so that the sperm can pass. The sperm that is going to be used in the procedure– whether from the partner or a donor – has to undergo analysis. The IUI procedure is scheduled if all this looks good.
In case if the patient is not ovulating regularly, the doctor may prescribe fertility drugs for inducing ovulation. IUI patients usually have their ovaries stimulated before the insemination takes place. This helps in maturing eggs and taking the trigger shot helps in releasing the egg. The process of stimulation can take about 10 days. After all this, the sperm must be prepared for the insemination to occur.
It is also recommended that the IUI patient abstains from sex for 2 or 3 days before the procedure.Consult with the doctor to find out if there are any other recommendations specifically for you.
What are the risks and complications in IUI?
IUI is considered a low-risk procedure, but no procedure is completely risk-free. The risks associated with this process are very minimal. Few risks that the IUI procedures have are:
Risk of Multiples
The conception of twins or more children with IUI is rare. Conceiving twins is a side effect of fertility drugs consumed during the IUI procedure. Multiple pregnancies can increase the risk of miscarriage, gestational diabetes, premature delivery, preeclampsia (high blood pressure), complications at birth, and low birth weight of the baby.
Risk of Ovarian Hyperstimulation Syndrome (OHSS)
The use of fertility drugs in IUI can result in Ovarian Hyperstimulation Syndrome (OHSS). Fertility drugs like Letrozole or Clomid are used before an IUI cycle. In some cases, it can lead to hyper ovulation which pumps up the body's estrogen levels. This results in inflammation of the ovaries and enlarged ovaries can lead to severe abdominal pain, bloating, vomiting, breathing issues, or nausea.
When the catheter is placed through the vagina, it can cause a small amount of vaginal bleeding. However, this does not affect the chances of pregnancy.
Risk of Infection
There are slight chances of infection during the IUI procedure as it requires inserting a catheter to place the sperm in the uterus. There is a small chance of injury to the cervix that may cause spotting, bleeding, or acute pain after the procedure. Therefore, doctors advise resting for sometime after the procedure. This reduces the chances of any possible distress.
What is the IUI cost in India?
IUI is a very small, less time consuming in-clinic procedure. It may cost you around Rs. 5000- 40,000 in India depending upon the severity of your condition. But it differs depending upon various factors.
- Location (city/town)- the location of the clinic or hospital plays a very important role when determining the price range for the treatment. Like, a clinic or hospital will charge more if that is situated in a metro city or tier 1 city because of the cost of living, spending capacity of the people, use of advanced technology, and equipment, etc. Normal IUI treatment cost in cities like Bangalore is Rs.16,000, Pune, Nagpur, and Delhi- Rs. 15,000, Hyderabad- Rs. 17,000, Kolkata- Rs. 18,000, Chennai- Rs. 19,000, Mumbai- Rs. 20,000.
- Number of consultations required- sometimes you are advised to come to the clinic more than once, depending upon the severity of your condition. This repetitive visit will charge you more than usual because per visit to the doctor may cost you around Rs.2000-4000.
- Type of IUI- there are different types of IUI. Depending upon the procedure you are choosing the cost of the treatment may vary. The cost of IUI with oral medication is around 10,000-20,000 whereas the cost of IUI with injectable fertility drugs is around 25,000-40,000. So, the type of IUI procedure you are taking also matters a lot.
- Age of the patient- age of the patient is also a cost determining factor as the older the patient is the costlier the treatment will be. Because the age of the patient determines complications and struggles related to the procedure. Complications increase with age. And when the complication increases the physician faces more difficulties to achieve the desired result. This may cost you more because of repetitive try.
- Brand name of the clinic/hospital- Brand name of the hospital or clinic demands more money than required as they claim quality care at its excellence. It may also be their business advantage because of which you need to spend that much money per case. Whatever the reason may be, it can affect your pocket.
- Repetitive diagnostic tests- sometimes your doctor may ask you to get a few tests repetitively for more clarity. A pelvic ultrasound scan will cost you around Rs. 1, 000-2, 500, semen analysis will cost you approx Rs.1, 500-2, 500, a virology screening test for both you and your partner will cost you around Rs.1,000-1500, hormonal tests like Anti-Mullerian Hormone (AMH) can cost you around Rs. 1, 000-1, 500. So, the repetition of these diagnostic procedures can burn a hole in your pocket. Your doctor can also ask you for additional diagnostic tests like HyCoSy, sperm comet test, testicular biopsy, rubella, CMV, or chlamydia which may also increase the cost to Rs. 20,000-40,000 in total.
- Donor sperm- when you choose to get inseminated with donor sperm, then it may cost you higher. Because preservation methods of sperms are costly. The cost is influenced depending upon the sperm quality, quantity, and lab you approach. It may cost you around Rs. 10,000-15,000 additionally.
- Number of cycles- if you get a positive result in one cycle then it's good. But most of the time that is not what happens. You may have to opt for more than one cycle to get the desired result. So, the more cycles you will go with the more money you will have to pay.
Intrauterine Insemination (IUI) is a relatively simple fertility treatment when compared to IVF. IUI is also known as alternative insemination, artificial insemination, or donor insemination. In IUI, the sperm cells are directly placed into the patient’s uterus around the time of their ovulation. This helps the sperm get closer to the egg. It is also a cost-effective method of treatment and has a very low risk and chances of complications.
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List of ReferencesHide
Willem Ombelet. “The revival of intrauterine insemination: evidence-based data have changed the picture”. Published online 2018 Feb 16, PMID: 29479397.
B J Cohlen, P Vandekerckhove, et al. “Timed intercourse versus intra-uterine insemination with or without ovarian hyperstimulation for subfertility in men”. Cochrane Database Syst Rev. 2000;(2):CD000360, PMID: 10796711.
Gautam N. Allahbadia. “Intrauterine Insemination: Fundamentals Revisited”. Published online 2017 Oct 25, PMID: 29162950.
E. Kalu, M. Y. Thum, et al. “Intrauterine insemination in natural cycle may give better results in older women”. J Assist Reprod Genet. 2007 Mar, PMID: 17226077.
Ilkka Y Järvelä, Juha S Tapanainen, et al. “Improved pregnancy rate with administration of hCG after intrauterine insemination: a pilot study”. Published online 2010 Feb 23, PMID: 20178630.
Marshburn et al. “A short period of ejaculatory abstinence before intrauterine insemination is associated with higher pregnancy rates”. Vol. 93, No. 1, January 2010.
Mayo Clinic Staff. “Intrauterine insemination (IUI)”. mayoclinic.org, July 16 2019.
Last updated on: : 15 Oct 2020
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