Artificial insemination is a technique where fertility
is facilitated by inserting several sperms directly into the
female genital tract. Depending upon the quality and the sperm
count, insemination is can be performed by two methods:
A)Artificial Insemination For Husband(AIH): The male
collects the semen by masturbation and then this is artificially
placed in the vagina, on the mouth of the womb (cervix), with
the aid of a syringe.
B) Intrauterine Insemination(IUI): The semen is collected
by masturbation, which is processed in the laboratory. The
seminal plasma is discarded and the best quality sperms are
harvested and kept in special culture media. The ratio of
half to one ml of sperms are then artificially deposited into
the uterine cavity with the aid of a thin catheter IUI.
Men who are unable to ejaculate in the vagina. This
is the classical indication. Causes for ejaculation failure
where sperms are released backward into the bladder instead
of urethra. Retrograde ejaculation may be due to diabetes,
trauma or operation in neck of the bladder or a side effect
due to some drugs.
mildly low sperm count, poor quality sperm or antisperm antibodies.
wish to freeze their sperm for possible future use before
or radiotherapy for cancer.
Women with mild endometriosis
Women with cervical mucus
hostility or poor cervical mucus
Couples with unexplained infertility
Indications For IUI Using Donors Sperm
Sometimes males do not respond to the the actual cycle of
IUI. Even other ART methods might fail. In such cases fertilization
can be achieved by performing IUI with donor sperms. This
treatment can also be beneficial under conditions of:
Males with azoospermia
and who cannot afford advanced treatments such as ICSI.
Males with genetic disorders, which can be prevented from
being transmitted to the child by using donor sperms.
What are the minimum requirements
for undergoing an IUI?
Ideally a patient should :
than 40-41 years of age
one potent (open) fallopian tube
minimum sperm count of at least 10 million or a count following
washing of semen of at least 3-5 million motile per ml.
The potency of the fallopian tubes can be ascertained by either
or an Hysterosalpingography.
At Babies And Us, we treat patients with extremely low sperm
counts. In such cases we advocate 3 to 6 IUI cycle attempts
with simultaneous treatment for increasing counts by a male
specialist. The success of IUI in patients with very low sperm
counts is low. Consequently, those who fail to become pregnant,
are advised to opt for ICSI or Donor Insemination.
Procedure of IUI
Ovulation stimulation and monitoring. The IUI can be done
in a natural cycle or stimulated cycle.
The growth of a single egg in the growing follicle is monitored
through vaginal sonography. Once the single follicle has reached
an average diameter of 1.8 to 2 cm, an HCG injection is given
to bring about ovulation(release of egg from the follicle)
and IUI is done after 36 to 40 hours.
Multiple egg formation is achieved through drugs such as Clomiphene
Citrate, Gonadotrophins(FSH or HMG) alone or in combination
with clomiphene or GnRh analogues. A key requirement for most
ART treatments is the stimulation of multiple follicles for
the production of more than one mature egg, as this is generally
associated with improved chances of conception. The growth
of the eggs is monitored through vaginal sonography that shows
follicle size and number.
Occasionally a blood level of serum Estadiol hormone (E2 Level)
may be done. Once two leading follicles have reached a size
of 1.8- 2 cm, HCG injection is given to bring about ovulation
and IUI is done after 36-48 hours.
IUI at Babies And Us
Normally our unit does four IUI cycles using Clomiphene. If
this fails to achieve pregnancy, we use a combination of Clomiphene
with Gonadotrophins (FSH),
and try out 3-4 cycles. If this fails to achieve pregnancy,
we try out 3 cycles with pure Gonadotrophin drugs, with or
without GnRH analogue.
In case this also fails, we go for either IVF or ICSI treatment.
Timing of IUI
The patient is called for IUI 36 -40 hours after HCG injection
(at the time of ovulation). The incidence of ovulation is
confirmed through a sonography, prior to the insemination
or at times two inseminations are performed- one after 24
hours and the other, 48 hours after HCG. At Babies And Us,
only a single insemination is done within 36-40 hours and
we do not perform an ultrasound to confirm ovulation. Our
protocol is less cumbersome and yields the same success.
The husband is given a sterile container, specially imported
from Britain. He is asked to produce sample by masturbation
in a semen collection room. Alternatively, he can also produce
the sample at home, provided he can come to the clinic within
a period of 30-45 minutes. In case of difficulty, various
options may be tried out, as elaborated in the section on
It is important not to use any lubricant, including soap for
The semen is processed in the laboratory, using specially
media. The semen can be processed and washed either
by the standard swim-up method or the density
gradient method using pure sperm. To maintain the
potency of the sperms the Babies And Us laboratory uses specially
imported media - plasticware and disposables, thus avoiding
toxicity to the sperms. We do not recycle anything in the
lab, thus avoiding infection and maintaining high pregnancy
rates. Using imported carbon dioxide incubators the best quality
sperms are harvested. These are floated in half to one ml
of media, which is then used for insemination.
IUI is a short procedure, lasting
about 2 hours, from the time semen is produced till the time
the patient is released from the hospital.
It involves placing the sperms directly into the uterus thereby
bypassing the cervix. The rationale for doing this is reduce
the effects of vaginal acidity and cervical mucous hostility
and to take advantage of the available, large number of good
and highly motile sperms.
is placed on the table, the vaginal speculum is inserted and
the cervix (the mouth of the uterus) is exposed.
is cleaned with saline. No antiseptics are used, as they can
kill the sperms. (It is important to note that the jelly used
for vaginal sonography is also toxic to the sperm. Hence it
should not be used on the day of the insemination, if a vaginal
sonography has been planned.)
suspension is then taken in a syringe.
IUI Cannula, imported from Holland, is attached to the syringe.
The Cannula is passed into the womb, and the sperm suspension
is gently deposited in the uterine cavity. The use of washed
semen has been known to have significant increase in pregnancy
rates and side effects like uterine cramps and infection also
do not occur.
The procedure is painless in most women, and takes about 5
minutes to perform. The woman is made to sleep on the table
for 15 minutes after which she is sent home.
Do I need to take any drugs, following an IUI?
Yes. The patient is given a mild antibiotic such as Cephalosporin
or Doxycyclin, for four days.
This is combined with a vitamin. She is also given Luteal
support either in the form oforal progesterone such as Duphaston
or vaginal pessaries (tablets) like Microgest or Puregest
for 14 days. After 14 days, she is asked to do a pregnancy
blood test called B HCG. If pregnancy is confirmed, the Luteal
support is continued for an additional duration of 2 months.
What are the success rates of IUI?
The success rates vary from 10-20 % per cycle depending
on the cause of infertility. The best results are seen among
patients with cervical factor and IUI using donor sperms.
IUI success is usually low among patients with severely low
semen counts- less than 10 million per mil. g
On the whole, if 10 patients undergo IUI every month, one
or two will become pregnant every month. In about 6 months
time out of the ten patients who started treatment, 4 to 6
patients will become pregnant. The rest would have to be treated
with advanced procedures such as IVF or ICSI to achieve pregnancy.
Can the semen be processed by Babies
And Us, if the Insemination is done by the patients' neighbourhood
Yes, Babies And Us provides qualitative laboratory
facilitities to process semen for international as well as
domestic patients. Typically in such a scenario, the husband
produces the sample at our locations.
This is processed. The IUI ready sample is placed in special
Australian or German make portable Incubators, which can be
carried by the husband to the Gynecologist. After the completion
of IUI treatment, the Incubator is then returned to the lab.
A facility like this one offers convenience and is also economical.