Intrauterine Insemination

Infertility is the inability to contribute to conception by a woman within after 12 months of unprotected intercourse. The reasons could be related to either or both of the partners (male and female). One of the relatively simple fertility treatments or assisted reproductive technology in India is intra-uterine insemination (IUI) or artificial insemination.

It is the procedure of artificially transferring semen into the reproductive system of a woman and includes insemination with the husband’s semen or with donor semen. IUI can be done with or without drugs.

Indications

IUI treatment is mostly recommended by the fertility hospitals in India for the following circumstances;

• Male infertility
• Hostile cervical mucus
• Unexplained infertility
• If treatment with fertility drugs fails to deliver results
• If sperms are used donated by a sperm donor
• If intercourse is not possible because of sexual pain

As per fertility doctors in India, IUI is not useful for the following cases;

• Blocked fallopian tubes
• Severe endometriosis
• Previous pelvic infection

Cost

If fertility drugs fail to deliver results, IUI may be the first tried. Compared to the other assisted reproductive technologies it's easier to do IUI. IUI costs much less (generally around Rs 5,000) than other fertility treatments. IUI is considerably cheaper than In vitro fertilization (IVF).

Risks

Compared to other treatments IUI is a relatively low-risk procedure. There is a very little risk of getting an infection because of IUI.

Generally, most of the serious risks come from the use of fertility drugs. If a woman is using any such drugs, it may build the risk of developing Ovarian Hyperstimulation Syndrome (OHSS).

There is also the risk of conceiving multiples (twins, triplets, or even more) is high. This makes monitoring vital.

Because of too many potential follicles, the cycle might be canceled and tried again at another time in the future, and doctors might advise abstaining from sexual intercourse. It is important to stick to the instructions seriously. Though, if the couple has sex and conceive, they put themselves and the future babies at risk.

The Procedure

The IUI procedure is pretty simple. Generally, IUI is done in the fertility clinic. The sperm will be thawed and prepared, if a woman is trying to conceive with the help of sperms donated by a sperm donor. If not, the couple will have to visit the clinic for a day and the male partner is to give his semen sample. The semen sample is generally achieved through masturbation. And a semen analysis is done.

The male partner has the option of using a sterile home collection kit, if he fails to produce a semen sample at the clinic. Couple must keep in mind that for this method, it is necessary to get the semen sample to the clinic within an hour of collection. Also, the semen sample must be kept at body temperature until it is delivered to the clinic.

Semen encompasses more than just sperm. Generally, to remove the impurities, leaving only what is needed for conception, doctors put the semen through a special “washing”. A woman will be required to lie down on a gynecological table, for the procedure of IUI.

A small thin tube called a catheter is placed in the cervix. This might make the woman feel mild cramping, similar to what one feels while a pap smear is done. Then with the help of a catheter, the specially washed semen is moved into the uterus. Once the semen is transferred into the uterus, catheter is removed. After the procedure, it is advisable for the patient to remain in the same horizontal position for a short time. The woman need not worry about the sperm falling out when standing up, as the sperm are moved directly into the uterus.

Success rate of IUI

Though several factors affect the success rate of IUI, the age of woman (less than 35 years have higher success rate), number of cycles of IUI, semen quality, etc.

Legal implications

The Assisted Reproductive Technology (Regulation) Bill 2017 has been approved by the Cabinet during February 2020. It seeks to regulate and supervise assisted reproductive technology clinics and the assisted reproductive technology banks, for prevention of misuse and for safe and ethical practice of assisted reproductive technology services and for matters connected therewith or incidental thereto.