IUI Treatment in India

Intrauterine insemination (IUI) also called, artificial insemination, is one of the most cost-efficient and effective infertility treatments of modern times. It is an artificial reproductive technique where the women's uterus is artificially introduced to the male sperms with the help of a flexible tube.

Once the male sperm is separated and washed from the semen ejaculation, it is injected deep inside the uterus, close to the ovum to facilitate fertilization. This process of IUI is painless and only takes a few minutes.

Although IUI is commonly used to treat male infertility, it can also be used for certain conditions affecting females.

IUI is an effective mode of treatment for the following conditions:

• Unexplained Infertility:

Unexplained fertility is the condition where the exact cause of infertility can not be determined even after a thorough examination by the fertility expert. Couples suffering from this condition can opt for IUI treatment for a successful pregnancy.

• Endometriosis:

Endometriosis is a condition where the inner lining of the uterus, known as endometrium, starts to abnormally grow outside of the uterus. IUI is an effective mode of fertility treatment for women suffering from mild cases of endometriosis (stage1 or stage 2 endometriosis).

• Cervical Factor Infertility:

A woman's cervix produces a mucus-like substance known as cervical mucus to provide nourishment and an ideal environment for the sperm to travel from the vagina to the eggs and facilitate fertilization.

An abnormal cervical mucus such as thick consistency mucus prevents the sperm from travelling towards the eggs, making the pregnancy unsuccessful.

Pregnancy through IUI is highly successful in such cases as the artificial insemination process bypasses the cervical mucus and sperm is injected straight into the uterus, helping fertilization.

• Ovulatory Factor Infertility:

As the IUI procedure is done only after stimulating ovulation, artificial insemination is also recommended for women suffering from some ovulatory abnormalities like irregular menstruation and PCOS (polycystic ovarian syndrome).

It is important to note that IUI is not recommended for conditions like severe tubal blockage, diminishing ovarian reserve, and ovarian failure.

• Mild Male Factor Infertility:

IUI can be used in cases where the semen analysis report suggests normal sperm evaluation, but the couples are unable to conceive. Artificial insemination requires separation of highly motile sperm from the semen during the sperm wash process. These motile sperm are then directly injected into the woman's uterus.

• Azoospermia or absence of sperm in male:

Azoospermia or complete absence of sperm can cause male infertility making it difficult for the couple to conceive. Under such conditions, donor sperm IUI is performed. The sperm from the male donor is injected into the woman's uterus during IUI treatment.

• Semen allergy:

Some women are allergic to the protein present in their partner’s semen. Hence, contact with semen can cause redness, rashes, and swelling in their vagina. IUI can be an effective mode of treatment for women allergic to semen protein as many proteins are removed from the sperm before it is injected into the uterus.

The IUI treatment is not recommended for women or men suffering from below-mentioned issues:-

• Women whose fallopian tube is severely blocked or damaged
• Women with a severe case of endometriosis
• If there is a history of pelvic infection
• Cases of diminishing ovarian reserve (high FSH) or menopause.
• If the woman is older than 40 years - in case of older women IVF treatment is preferred
• Severe male factor infertility: The possibility of effective IUI is close to zero if the sperm count and motility are abnormal or very low. For example, the probability of successful IUI is significantly reduced if the motile sperm count is below 10 million at the time of insemination. In these cases, In-Vitro Fertilization (IVF) along with ICSI is the best course of treatment available to the couple.

While choosing the fertility treatment options, you might feel lost with all the medical jargon and terminology. It is important to be fully aware and understand all the options available for treatment.

There are mainly four types of IUI treatment available, your doctor will recommend any of the below options of IUI treatment after your thorough examination.

The four types of IUI treatment are:-

• Intracervical Insemination

Intracervical insemination is the most common and least costly method of artificial insemination. The semen is directly introduced to the female cervix by the fertility expert with the help of a long needleless syringe.

The woman might have to wear a conception cap for some time, after the insemination to hold the semen.

• Intrauterine Insemination

Intrauterine insemination is the most effective artificial insemination technique. Under this procedure, washed sperms are directly injected into the female uterus, increasing the chances of successful fertilization and implantation.

• Intrauterine Tuboperitoneal Insemination

This procedure is similar to intrauterine insemination but it includes the injection of sperms in the fallopian tube also along with the woman's uterus.

• Intratubal Insemination

In this process, prewashed sperm is straightaway injected into the woman’s fallopian tubes only. The fertility expert will use a long flexible catheter to introduce washed sperm directly into the woman's fallopian tube.

As every individual is different, hence it is tough to have one size fit all approach while treating infertility. Your fertility expert will be able to decide the best course of action for you after you and your partner's thorough examination.

Your doctor will advise you and your partner to undergo various tests before starting the IUI treatment to diagnose the underlying cause of infertility.

These pre-screening tests will help doctors in planning the best mode of fertility treatment individualized to your needs.

With the help of these tests, your doctor will be able to answer these questions:

• Is the female ovulating?
• Are your fallopian tubes normal?
• Is your uterus ready for implantation?
• Are the male sperm count and function normally?

Once the issue is detected, then a course of treatment is planned as per your condition. The recommended approach would depend on factors such as your age, your diagnosis, the duration of infertility, previous treatment, and your personal priorities. Even though all patients don’t need to undergo these diagnostic tests, to prepare an ideal treatment plan and achieve the ultimate goal of pregnancy, such thorough diagnostic evaluation is needed.

Before suggesting the IUI treatment, your fertility doctor will recommend a battery of tests to better evaluate your condition and plan the best course of treatment.

These tests will help in better planning of treatment and considerably reduces the chances of failure.

1. General Screening Tests:

• Infectious screening

Both you and your partner are screened for various infections. The infection screening test includes chlamydia antibody, gonorrhea, hepatitis B, hepatitis C, syphilis serology, HIV test, etc.

• Pre-pregnancy screening

The pre-pregnancy screening test includes complete blood count (CBC test), blood type, Rh factor, and Rubella Titer. These tests help in protecting the fetus from serious complications and potential disorders during pregnancy.

• Pituitary/ Thyroid Screening

Abnormal hormone levels during pregnancy may harm you and your baby's health. The doctor will recommend hormone tests like TSH, prolactin, T4 test, and T3 test beforehand to eliminate any risk on future pregnancy.

• Genetic Screening

A genetic screening test is done to identify genes linked to certain diseases such as cystic fibrosis, fragile X syndrome, blood disorder like sickle cell anaemia, and Tay-Sachs disease.

Your doctor may prescribe you the genetic screening test after taking your medical history if you are at the risk of developing these conditions.

• Pap smear test

This test helps in detecting cervical cancer, other issues associated with the cervix, and sexually transmitted diseases. Any of these disorders can prevent you from becoming pregnant.

1. Ovarian Function and Ovarian Reserve Screening

Almost 30-35% of females experience infertility due to underlying ovarian disorder. The ovarian reserve testing helps in identifying any anatomical or other defects related to female reproductive organs.

The ovarian reserve testing includes:

• Baseline Ultrasound

Both abdominal ultrasound and transvaginal ultrasound are performed around the time of your menstruation to examine your ovaries and other reproductive organs.

• Day 3 Blood Work

Day 3 blood work test is done on the third day of the menstruation cycle, and the level of various hormones like FSH, LH, and E2 are tested. By looking at the levels of hormones such as Follicle-stimulating hormone, Luteinizing hormone, and estradiol at the beginning of a monthly cycle, a doctor can get information regarding a woman’s ovarian reserve.

1. Fallopian Tube Evaluation

30% of female infertility is associated with issues related to the fallopian tube. The most common fallopian tube problems are tubal blockage, scarring from a previous undiagnosed pelvic infection, stomach infections such as appendicitis, previous surgery, ectopic pregnancy, and endometriosis.

The fertility expert will advise the fallopian tube evaluation to find the underlying cause, if any, and design the treatment plan accordingly. .

• Hysterosalpingography

Hysterosalpingography (HSG) is an X-ray procedure for determining the blockage of the fallopian tubes. The X-ray is taken after injecting a contrast medium into the uterus and fallopian tubes with the help of a cannula through the vagina.

1. Uterine evaluation

The inner lining of the uterus is called the endometrium. It is here where the fetus gets implanted and starts developing during pregnancy.

It is important to thoroughly evaluate the uterine cavity to identify any complications that might affect the implantation of the fetus.

Common uterine wall defects include uterine scar tissue (because of a previous pregnancy or other processes), polyps, fibroids, or any structural issues in the uterus.

Depending on your unique situation, the following tests can be included in the On the basis of your situation, the following tests can be included in the evaluation.

• Baseline pelvic/vaginal ultrasound

It is usually done on the second, third or fourth day of the menstrual cycle. It helps the doctor to determine the appropriate time for ovarian stimulation for IUI treatment.

• Hysterosalpingogram (HSG)

This helps in detecting structural defects in the uterine cavity and fallopian tube.

• Sonohysterography/Sonohysterogram-saline sonography

Sonohystogram is an imaging study of the uterine cavity. In this test, the uterine wall and uterine cavity are evaluated by injecting a small amount of sterile fluid in the uterus. This test helps in detecting abnormalities in both the uterine wall and cavity.

• Diagnostic Hysteroscopy

Diagnostic Hysteroscopy is performed to evaluate the endometrial cavity. This test is recommended for women undergoing fertility treatments or whose Sonohysterography results are doubtful.

• Endometrial Biopsy

Endometrial biopsy is done to check the abnormal cell growth of the endometrium. The biopsy results show cell changes linked to hormone levels, or abnormal tissues, such as fibroids or polyps. An endometrial biopsy also detects uterine infections like endometritis.

About 40% of total infertility cases are due to male factor infertility. Your doctor will advise you to undergo complete physical examination and batteries of tests to identify the underlying cause of infertility. The test results will help your fertility expert in determining the best available treatment options.

Your doctor will advise you tests like,

• Semen analysis

An experienced andrologist analyzes the semen under a microscope to know the viability and count of sperms. The semen analysis helps your doctor in understanding the sperm morphology and sperm count, and eventually, help in determining the most effective fertility options.

Based on your semen report, your doctor will advise you one of these treatment options, timed intercourse, intrauterine insemination (IUI), conventional IVF, intracytoplasmic sperm injection (ICSI), which can be done during ovulation.

Some of the available options are timed intercourse, intrauterine insemination, conventional IVF, intracytoplasmic sperm injection (ICSI), which can be done during ovulation.

• Anti-sperm antibodies

This test detects the presence of abnormal particles called antibodies, in blood and Antisperm antibody test detects special proteins (antibodies) that destroy man's sperm in blood, vaginal fluids or semen. These antibodies, if present, will damage or kill sperm making the fertilization of egg difficult.

Infertility caused due to these antibodies is called immunologic infertility.

• Karyotyping

Karyotyping is a chromosomal analysis that helps in detecting potentially significant abnormalities that can cause problems in fertilization and pregnancy. If your doctor suspects chromosomal abnormalities, he might advise IVF treatment along with Preimplantation Genetic Diagnosis (PGD screening).

• Y chromosome deletion testing (genetic disorder testing)

Male infertility could be because of a genetic disorder called Y chromosome microdeletion (YCM). The man suffering from Y-chromosome infertility may produce either very few sperm cells (oligospermia), no sperm at all (azoospermia), or sperm cells with abnormal morphology.

Y chromosome deletion testing (genetic disorder testing) is the blood test that can reveal the mutation in the Y chromosome. Men with oligospermia may also be helped with assisted reproductive technologies; most men with Y chromosome infertility have some sperm cells in the testes that can be extracted for this purpose.

• Sperm Chromatin Structure Assay (SCSA)

The sperm chromatin structure assay test is a new diagnostic tool that can detect DNA fragmentation in the sperm. The high degree of DNA fragmentation in sperm prevents full-term pregnancy leading to miscarriage.

This test is advised for couples who have experienced multiple miscarriages. Although the good news is that innovative reproductive techniques such as IVF along with ICSI can help in getting pregnant.

• Testicular Biopsy

Your fertility expert may suggest a testicular biopsy if the semen analysis suggests abnormal sperm and the cause is not identified.

During a testicular biopsy, a sample from the testicles is collected with the needle and analyzed in the laboratory. In some cases, sperm collected during the biopsy can also be used for fertility treatments like IVF and IUI.

Your doctor will prescribe you a battery of tests to finalize the most efficient treatment plan and achieve the ultimate goal of pregnancy.

Most of the IUI treatment cycles are done after inducing ovulation in the woman. To have more follicles, and release more than one egg and develop better quality egg, the woman is given ovulation stimulant drugs before starting the IUI.

Doctors may not prescribe ovulation stimulating drugs in women with healthy eggs. Though in other circumstances, where the quality of eggs is low, ovulation stimulating medication is required.

Before taking any injectable drugs, a woman has to undergo a baseline ultrasound and a blood test.

Some of the most commonly used ovulation induction medicine are as follows:

• Oral Tablets

Oral medications like Clomid and Letrozole are used to induce ovulation in women who are unable to ovulate on their own or have irregular ovulation. The ovulation induction medicine stimulates the release of hormones that drives egg production and release. Your doctor will prescribe Clomid or letrozole to be taken between days three and seven or between days five and nine of your menstruation cycle.

• Injectables or Gonadotropins

If you are unable to ovulate even after the oral medication, your doctor may prescribe injectable medications like follicle-stimulating hormone (FSH) and luteinizing hormone (LH). These preparations are taken by subcutaneous injections or intramuscular injections to stimulate ovulation. These medicines provide more powerful stimulation as compared to oral tablets and would require constant monitoring.

After the ultrasound and blood work on the third day of your menstruation cycle, your doctor will put you on hormone injections. The injectable medications are started on day three and are continued for six to 10 days, depending on response. During this, your doctor might ask you to undergo two or three ultrasound and blood work to monitor the progress.

Ovulation monitoring is important in every fertility treatment. In IUI or artificial insemination, the frequency of monitoring differs according to the types of the cycle.

• IUI with the natural cycle

Natural cycles with IUI treatment requires the least amount of monitoring. Over the counter ovulation predictor kits (LH predictor kits) are used to find the correct time of ovulation, and IUI is planned accordingly.

Your doctor might also advise an ultrasound between day 11 to day 14 of your menstrual cycle to determine the growth and maturation of ovarian follicles. Afterwards, HCG is administered which will stimulate ovulation within 36 to 44 hours. Once the ovulation begins, the insemination of male sperm is done.

• Clomid Cycle or IUI with Oral Tablets

IUI treatment with clomiphene citrate cycles is monitored more closely. Your doctor will advise ultrasound on days 2, 3 or 4 of your cycle to rule out ovarian cyst before starting the Clomid. Taking Clomid despite having an ovarian cyst can lead to an abnormal reaction and enlargement of existing cysts.

If the ultrasound shows no cysts, your doctor will prescribe from 50 to 150 milligrams of Clomid for 5 days. During the middle of the cycle (between 11–14 days), an ultrasound is done to measure the number of mature follicles (20–24 mm) and evaluate the endometrial lining.

Once mature follicles are present then HCG is given to stimulate ovulation, and within 24-48 hours of that IUI is done.

• IUI Treatment with Gonadotropin Cycles (Fertility Shots)

IUI treatment with a fertility shot is more expensive due to the need for extra medicine, blood work, and ultrasound. Under this type of IUI treatment, baseline ultrasound is done between 2nd to 4th day to ensure the absence of ovarian cyst. After this, injectable medication is given.

For a few days, blood work is done and blood hormone levels are tested to monitor the growth of follicles and ensure that the ovaries are not overstimulated (Ovarian hyperstimulation syndrome). If too many follicles develop simultaneously then the risk of having multiple pregnancies increases. The presence of too many follicles (more than 4 to 5) can indicate the cancellation of the cycle.

There is about a 20 % risk of having twins with the gonadotropin cycle. Once the right number of mature follicles (between 1–4) is determined, HCG is introduced to stimulate ovulation, followed by insemination.

To get good quality sperm, one must abstain from ejaculation for about 2 to 4 days before providing the semen sample. The semen can be collected at home or in a clinic and is stored in a sterile sample cup. In cases of home collection, the semen must reach the lab within an hour of ejaculation. Once at the lab, the semen is safely kept at a dark temperature-controlled place.

The sperms are separated from the semen by the process of sperm washing. Sperm washing is a technique where chemicals that may cause an adverse reaction in the uterus are removed from the semen. Sperm processing takes about 30 to 90 minutes.

The best quality sperms are used for insemination. In certain cases such as logistic concerns, oligospermia, or ejaculatory dysfunctions, the best quality sperms are separated, frozen and stored in the laboratory for later use. The cryopreserved sperm is melted 2–3 hours before the process of insemination in the clinic.

The insemination must be done at the right time. It should either be done during ovulation or right before ovulation. Usually, the sperm can stay alive in the female reproductive tract for up to 5 days (after having intercourse), because of which they can fertilize an egg. Although, the egg can be fertilized only within 12–24 hours post-release.

IUI insemination must be at the right time so that the egg and the sperm are present in the fallopian tube at the same time. That’s why the process of IUI is mostly done one or two days after ovulation. Your fertility expert will align the insemination date with your ovulation dates.

The process of insemination is done in the fertility clinic under your fertility experts' guidance. Insemination is a quick process and usually requires only a few minutes. The total time for one cycle is roughly about 15 to 20 minutes.

• During the procedure

During the procedure, you will be asked to lie down on the table and your feet would be put in the stirrups. Then a speculum would be inserted in your vagina — the experience will be quite similar to what you had during your pap smear.

The gynaecologist will enter a flexible long tube (catheter) through your cervix into your uterus. The sperm is then pushed into the catheter with the help of a syringe.

• After the procedure

After insemination, your doctor will ask you to remain lying down with elevated hips for about 10 minutes. You are free to resume your normal activities after this. Some women might feel discomfort during the procedure and can experience cramps or spotting on the day of the insemination. The successful pregnancy can be tested within 14 days of insemination.

Your doctor will advise a pregnancy test after two weeks of insemination to confirm pregnancy and declare the IUI treatment successful.

If you take the pregnancy test too soon, you can get inaccurate results like,

• False-negative

The pregnancy hormone needs to reach an optimal level to be identified in the home pregnancy test. The pregnancy hormone reaches the optimal level after 14 days of insemination. If you take the test too soon, you might get a negative result even if you’re pregnant.

• False-positive

Ovulation inducing medications like HCG can lead to a false-positive result even when you are not pregnant. It is advised to take the pregnancy test again in case of a negative result.

You can discuss the next mode of fertility treatment with your gynaecologist if your IUI was unsuccessful.

It is essential to time the insemination in conjunction with the time of ovulation for maximum success. The eggs remain alive for only 12 to 24 hours after release whereas the sperm remain alive for 4 to 5 days inside the women's body. Hence, the IUI must be carefully timed so that the sperms are available in the woman's body at the time when the egg is released (ovulation).

Few studies suggest that two inseminations in successive days have higher chances of pregnancy than the single insemination whereas other studies show no such effects. The possible reason for the different findings is that if single inseminations are not accurately timed for ovulation, success rates would increase with a double insemination protocol. The bottom line is at least one of the two insemination needs to be correctly timed.

There is no one size fits all, in case of fertility treatment so your doctor will design your IUI treatment after having your thorough examination.

In general, women who are ovulating normally can try IUI for a maximum of 3–4 months whereas women having polycystic ovaries (PCOD) or are taking medication for ovulation can try longer (about 6 months). If the IUI with Clomid is unsuccessful, your doctors might suggest IUI with gonadotropins, before taking the IVF route.

In most cases, the success rate of IUI with gonadotropins is much higher than that of IUI with Clomid. 85–90% of women who get IUI with injectable gonadotropins conceive successfully after 4 to 6 cycles.

Even though the chances of a successful pregnancy with IUI is less than that of IVF, there are some benefits to this treatment. Such as,

• IUI has much better chances of conceiving than regular intercourse.
• Intrauterine insemination is much simpler than the IVF process.
• In IUI, the natural cycle is followed which is less aggressive on the woman’s body and uterus than IVF.
• The chance of developing ovarian hyperstimulation syndrome is relatively small in IUI.
• IUI helps you understand how your body would react before going to IVF.

IUI is also less costly than IVF and hence is a more feasible option for every couple.

IUI is a relatively less risky procedure as compared to other fertility treatments, especially in terms of getting an infection. The biggest risk in IUI is due to the medicine used for inducing ovulation. If you’re using gonadotropins then you can have the risk of developing ovarian hyperstimulation syndrome.

Also, there is always the chance of having multiple pregnancies in IUI treatment. Multiple pregnancies might increase the chances of miscarriage, premature labour, gestational diabetes, low birth weight, preeclampsia, and complications at birth are increased.

Innovative technology treatments like IUI, provide a ray of hope for couples who are unable to become parents due to infertility. The success of IUI depends on many factors. The major determining factors are the age of the woman and the cause of infertility. The younger the woman is, the more likely she is to get pregnant through IUI.

• For women between 20–30 years of age: the success rate of conception is 18% and the success rate of delivery is 13%.
• For women between 30–35 years of age: the success rate of conception is 14% and the success rate of delivery is 10%.
• For women between 36–38 years of age: the success rate of conception is 13% and the success rate of delivery is 9%.
• For women aged 40 and above: the success rate of conception is 11% and the success rate of delivery is 7%.
• For women aged 50 and above: the success rate of conception is 6% and the success rate of delivery is 3%.

The first IUI attempt is more likely to be successful than the following ones.

Both Intrauterine insemination and In Vitro Fertilisation are fertility treatments used to help couples having trouble conceiving naturally.

Even though the result of both the treatment is successful pregnancy, there are many differences in their approach.

These are the following differences between IUI and IVF:

• IUI is a simple and less time-consuming process as compared to IVF treatment.
• In IUI the sperm is directly introduced into the woman's uterus to facilitate fertilization, whereas in IVF the fertilization is done in the laboratory.
• Two main steps of IUI treatment are sperm wash, and insemination whereas IVF includes steps like egg stimulation, retrieval, fertilization, and embryo transfer.
• The cost of IUI treatment is less as compared to IVF treatment.
• The success rate of IVF is more than IUI.

The IUI treatment process is quite easy, and it’s also quite likely to be successful but for that to happen, selecting an experienced and qualified doctor is very important. Before finalizing the IUI doctor, do thorough online research, find out more about the doctor's qualifications, behaviour with patients and pay attention to the fact that they are a fertility expert. Also, find out their success rate with IUI treatment. Finding a skilled doctor, trained in advanced fertility techniques is essential.

The best clinic and experienced fertility expert provide the best treatment. Keep the following points in mind while selecting the best clinic for IUI treatment:

• The IUI clinic should have all the equipment that is needed in the treatment.
• The clinic or hospital should have well-reputed, experienced and well-qualified doctors.
• The staff of the clinic should behave in a courteous and friendly manner with the patients.
• The fertility expert can answer all your queries and can manage your anxiety before the treatment.
• You can get information about the lifestyle, diet, and routine that you need to follow after getting the treatment.

IUI treatment is not costly in India, and the cost of a single cycle can be anywhere between Rs 5,000 to Rs 15,000. The total cost of IUI depends on the level of clinical monitoring and testing needed to track the development of follicles, ultrasound scans, and medicines.

The cost of IUI treatment includes the cost of processes done during the treatment, doctor’s consultation fee, ultrasound, and IUI injections. Apart from this, the cost of IUI treatment is also influenced by the age of the female, medical history, the number of required cycles and methods of inducing ovulation.

Usually, the packages available for Insemination through IUI include the costs of ultrasound and other tests, blood work, and the processes conducted in the lab, cost of insemination, doctor’s consultation fee, and other medical support fees.

The cost of an IUI treatment package in India increases or decreases as per your unique situation, such as whether you’ve had a miscarriage in the past or not, or a previous cycle of IUI hasn’t been successful, or the tests you need and the doctor’s consultation fee. Although the process of ovulation induction, monitoring, sperm extraction, and insemination can affect the cost of the package.

To know more about the IUI package, you can contact Zealthy. We provide you with the best IUI packages at the most cost-effective prices. For more information, you can contact us now @636-636-3030

If you are not financially sound or can’t pay a lump sum at once, then taking a medical loan for IUI treatment will be the best option for you. To get a loan at 0% interest, it’s very important to know the terms and conditions of the medical loan.

Zealthy can help you get a 0% interest loan for IUI treatment in India. To know more, you can contact us now.

The process of becoming parents with IUI is very easy. Although before opting for this course of treatment, the couple should find out about the cost, success rate of the IUI treatment along with a good hospital and doctor for IUI.