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Intrauterine insemination (IUI), also called artificial insemination, is a procedure which involves placing a concentrated amount of good quality sperm directly inside the woman’s uterus.
As a fertility treatment option, IUI is a simpler and more cost-efficient procedure than in vitro fertilisation (IVF). It is often recommended for younger couples with fewer fertility issues.
Why do you need IUI?
Your doctor may recommend IUI if you and your partner have the following:
Cervical factor infertility. If your cervical environment is not conducive or there are abnormalities, it can prevent the sperm from swimming through to reach and fertilise the egg. IUI bypasses your cervix and allows for a greater quantity of sperm to be deposited directly into your uterus.
Endometriosis-related infertility. Endometriosis is a painful gynaecological condition that affects your pelvic anatomy and reduces your chances of becoming pregnant. To improve the likelihood of pregnancy, ovulation medications may be used to help you ovulate before IUI is performed.
Mild male factor infertility (subfertility). In male factor infertility, there could be insufficient sperm in the semen (low sperm count), abnormalities in sperm size and shape (morphology) or the movement of sperm (motility) is poor. IUI helps to separate normal, highly motile sperm from lower quality sperm.
Ovulatory factor infertility. Some women have ovulation-related infertility such as insufficient eggs or lack of ovulation (no egg released). IUI is used in conjunction with ovulation induction medications to increase the chances of fertilisation.
Semen allergy. Some women have a rare allergy to the proteins found in semen. In such cases, IUI is used to remove these proteins before the sperm is deposited into the uterus.
Unexplained infertility. If you have tried to get pregnant for a year or more and your doctor has found no obvious problem with you or your partner, you have what doctors call 'unexplained infertility'. IUI is usually performed in this case as a first treatment along with ovulation induction medications.
What are the risks and complications of IUI?
IUI is a relatively simple and safe procedure, and the risk of serious complications is low. Risks include:
Infection
Multiple pregnancy - a multiple pregnancy (of twins, triplets or more) has higher risks than a single pregnancy does, including premature labour and low birth weight
Spotting (vaginal bleeding)
How do you prepare for IUI?
The IUI procedure involves:
Determining optimal timing. Ultrasound scans are performed periodically to track follicular growth. Once the follicle reaches a certain size, your doctor will advise you on the necessary steps.
Triggering ovulation. A hormone injection is usually given once your follicle reaches a certain size to trigger ovulation. IUI timing is crucial and is typically performed 36 hours after the injection.
Preparing the semen sample. Your partner will need to provide a semen sample. Highly active, normal sperm will be separated from lower quality sperm. A small, highly concentrated sample of healthy sperm will increase the likelihood of achieving pregnancy.
What can you expect in IUI?
IUI is usually a first-step procedure for treating infertility.
Estimated duration
The IUI procedure takes only a few minutes and requires no medications or pain relievers.
During the procedure
You can expect to go through the following steps:
You will be asked to lie down on the examination table and have your legs placed into stirrups
A speculum will be inserted into your vagina
A vial containing a sample of healthy sperm will be attached to the end of a long, thin flexible tube (catheter)
The catheter will be inserted into your vagina, through the cervical opening and into the uterus
The sperm sample will be pushed through the tube into the uterus
The catheter will be removed, followed by the speculum
After the procedure
You will be asked to lie on your back for a short while. After that, you can get dressed and go about your usual daily activities. You may have some light spotting for a day or two after the procedure.
You will be asked to take a pregnancy test after 2 weeks to find out if the procedure is successful. Your clinic will provide you specific instructions on this.
Consult with your doctor on the next steps if your IUI does not succeed. You may be asked to try IUI again for 3 – 6 months before moving on to other fertility treatments. Your doctor will do a clinical review and make recommendations to help you maximise your chances of pregnancy.
Do not be disheartened if you do not become pregnant through IUI. IUI is just the first step towards trying to conceive. Your doctor is well-versed in the various fertility treatment options and will be at hand to guide you through your treatment journey.
Frequently asked questions
A: You can help boost the potential for a successful IUI treatment by doing the following:
Avoid excessive stress and anxiety
To maximise the volume of semen and amount of sperm during IUI, your partner should avoid ejaculating for 3 days prior to your IUI
Ask your doctor about possible hormone injections to help stimulate the ovaries and produce viable eggs to be fertilised
Eat healthy and exercise regularly
A: Before and after an IUI, you can largely keep to your normal activities. You can try to increase your odds of a successful pregnancy by following the dos and don’ts below:
Do:
Take your folic acid during IUI treatment
Eat a balanced diet and take care of yourself
Exercise as you normally do but keep it light and low-impact, such as light aerobics, walking and yoga
Have sex regularly
Limit yourself to 1 cup of coffee or tea per day
Do not:
Engage in overly intense or strenuous exercise
Drink alcohol
Use hot tubs or saunas between your IUI and your pregnancy test
A: It is best to wait at least 14 days to take a pregnancy test after an IUI.
A: The process of fertilisation to implantation can take about 6 – 12 days, with an average of around 9 – 10 days.
A: Your doctor may have you start progesterone supplements right after your IUI to support your uterine lining and make it more receptive to implantation, as well as to help support early pregnancy.
A: IUI may not be effective if the fallopian tubes are blocked, or if the sperm count or motility of the sperm is low.
Under such conditions and if you and your partner have been unsuccessful in other types of treatment, your doctor may recommend IVF. In IVF, the egg and sperm are fused in an external laboratory environment.
The success rate of IUI or IVF is dependent on individual factors.
A: Although there is no limit to how many times you can go for IUI, the usual recommendation is to give IUI at least 3 tries before trying IVF.
A: If the treatment has been unsuccessful, you will start a period about 9 - 14 days after insemination.
A: Your baby due date is determined by when you ovulate, or in this case, from the date you had an IUI. If you are undergoing IUI, your due date is 266 days (or 38 weeks) later.
A: It is important for the man to avoid ejaculating for 2 – 5 days before the IUI so that his sperm count will be as high as possible.
A: A healthy uterine lining is crucial for conception and for supporting an early pregnancy.
You can consider natural treatments such as:
Acupuncture
Avoiding seasonal allergy medication or cold remedies, which can constrict blood flow
Engaging in moderate exercise, to increase your heart rate and promote good oxygenated blood flow to the uterus
Fertility massages, to improve blood flow to the uterus
Reducing your caffeine intake, to promote good circulation
Making sure you are a healthy weight, as a low BMI can reduce estrogen levels
Taking the right supplements, such as vitamin B, E and L-arginine to improve uterine thickness
A: It is difficult to predict the success of IUI as every couple responds differently to the treatment. Factors that can affect the outcome include:
Age (success rates for IUI tend to decrease in women over 40)
Underlying fertility conditions
Whether fertility drugs are used
Generally, the IUI success rate ranges from 9% – 15%.
A: Intrauterine insemination is a simple and generally painless procedure. Most women do not experience much discomfort. However, it is not unusual to experience cramping or slight bleeding during or after the procedure.
You should inform your doctor if your cramping is severe or accompanied by other symptoms like fever or abnormal vaginal discharge.
A: Intrauterine insemination (IUI) and in-vitro fertilisation (IVF) are two commonly used methods of fertility treatment to increase a couple’s chance of becoming pregnant.
IUI is a procedure in which processed and concentrated motile sperm are inserted directly into a woman’s uterus. This procedure is timed according to a woman’s ovulation to increase the chances of the egg and sperm finding each other.
IVF is the most successful method of fertility treatment used today to help couples to conceive. The process consists of:
Stimulation of the ovaries to produce multiple eggs at a time
Removal of the eggs from the ovary (egg retrieval)
Fertilisation of the eggs in the laboratory
Placement of the resulting embryos into the uterus (embryo transfer)
The chance of pregnancy from IVF depends on factors such as:
The age of the woman
The cause of infertility
Quality of the IVF laboratory process
A: Typically, patients will want to consider IVF after they’ve experienced 2 or more IUI cycles. Do have a discussion about this with your doctor, who will take into consideration other factors such as your age, health and reason for infertility.
A: IUI has not been shown to have a higher risk of miscarriages compared with naturally conceiving women.
A: IUI can be used as a fertility treatment option for women with endometriosis.
A: It is common for women to experience cramping during or after an IUI. Some women experience cramping right after the procedure as the catheter can sometimes irritate the uterus.
It is also possible to experience cramping a few days after an IUI. It can signal implantation, or that your body’s getting ready for your period.
You should inform your doctor if your cramping is severe or accompanied by other symptoms like fever or abnormal vaginal discharge.
A: While uncommon, natural conception after assisted reproductive technology (ART) such as IUI and IVF can occur.
One study found that out of more than 2,000 couples who attempted ART, about 20% became pregnant on their own after treatment. This is because some couples that come for fertility treatment are subfertile (when couples have a lower chance of conceiving on their own), and not infertile (when couples cannot conceive on their own).
To maximise your chances of conceiving naturally, you can try:
Having frequent intercourse (every 1 – 2 days) during your fertile period
Making lifestyle changes, such as quitting smoking and reducing alcohol consumption
A: Your partner should be available on the day of the insemination. It is recommended that he abstain from ejaculation 2 – 5 days before giving the semen sample.
He may also want to:
Avoid overheating (such as using the sauna and hot baths) or overcooling his body
Try to lead a calm lifestyle and limit physical activity
Abstain from sexual intercourse for 2 – 3 days, but no more than 5 days (as the quality of sperm deteriorates with longer abstinence)
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