How is intrauterine insemination done?
Intrauterine insemination (IUI) or artificial insemination (AI) is a minor fertility or basic fertility treatment and is indicated for only a selected group of patients.
The procedure for insemination would be that the fertility specialist may advise you, either to do as part of a natural cycle or use certain medicines for ovulation induction. Regarding the success rates, the success rates are usually better when used along with the ovulation induction agents. If you are planning to undergo an insemination, first of all, you would need to be checked for your patency of the fallopian tubes. Both you and your partner would need to undergo an infection screen for HIV, hepatitis B, hepatitis C, chlamydia and rubella immunity. So these are some pretreatment tests that needs to be done, and the patency of the tubes have to be confirmed.
Once all this is in place you are undergoing through an ovulation induction along with intrauterine insemination you would take pills such as Clomid or clomiphene or gonadotropin injections. You will undergo the follicle tracking just like any other ovulation induction patient.
Once you’re coming close to the ovulation or we are facilitating the ovulation by the use of particular medicine then you would be given an appointment to come in for the IUI or insemination.
On the morning of the planned insemination, your partner will produce a sperm sample which will be prepared and centrifuged and healthy-looking sperms will then be selected for instilling directly into the womb cavity.
You will have to undergo a gynaecological procedure which is very similar to performing a smear test. The selected semen fluid is then loaded up in a very fine plastic catheter and after the cervix has been visualised this catheter will be placed it within the womb cavity or the uterine cavity and then the sperm are released.
After that, you are then advised maybe to use some progesterone pessaries or suppositories to give extra supplements of the progesterone to help with the implantation. You will then take a pregnancy test in two or three weeks time. If the treatment is successful we would then prepare for a pregnancy scan; if unsuccessful you can proceed with the further insemination treatment.
Whether there are clear medical indications where we would recommend performing insemination before proceeding with IVF or there are situations where we apparently think we need to proceed with IVF.
In the above situation where we need to considering insemination first. The patient profile where we would recommend doing insemination first would be:
- a female agent is younger than 30 to 35
- trying to conceive only for 18 months
- they are anxious
- want to consider certain treatments
Then insemination may be a good starting point. The other subgroup of patients where we may recommend doing insemination first is where the patients are just not emotionally prepared to embark on the most complex treatment that has got it’s risks and complications and a lot of demand for the treatment.
Clinically where the female may have vaginismus, or there is a problem with the erectile function then again insemination is a first starting point.
IVF is explicitly recommended in patients if there is a failure of induction of ovulation despite using gonadotropin injections or multiple cycles then reluctantly IVF may be the way forward. Also in patients with moderate to severe tubal disease where there is blockage of both fallopian tubes or removal of both tubes then probably there is no other option but proceeding for them with an IVF treatment. And also if there is an involvement of male factor infertility again IVF or ICSI would be clearly indicated.
These are some of the indications where there is a fair degree of clarity as to what procedures may be required but in certain situations, the clarity may not be as much. However, we can consider based on patient information to make an inform decision.