Intrauterine insemination, which is one of the most commonly used assisted reproductive treatments in case of failure of pregnancy by natural means, is a treatment based on injecting the sperms obtained after washing the semen samples taken from the male, directly into the uterus of the female. Its main purpose is to increase the chance of fertilization by increasing the number of spermatozoa reaching the fallopian tubes. 1
The quality of the sperms placed in the uterus with the help of a thin, long and flexible catheter has an effect on the success rate of this treatment. For this reason, the semen sample taken from the man is subjected to special processes and the most mobile and healthy sperms are injected into the uterus.2
Fertility drugs can be used while IUI, which is an assisted reproductive treatment consisting of extremely comfortable and simple steps, or treatment can be performed without any drug treatment.3
In order to maximize the success rate of IUI, couples who want to have a baby should be evaluated together, and sperm and egg quality should meet the ideal criteria. For this reason, there are some tests that need to be done before IUI treatment.
Since it is one of the treatment methods used in case of failure of pregnancy by natural means, all necessary tests should be performed for the diagnosis of male and female infertility before IUI.
Before beginning IUI treatment, it is necessary to determine whether at least one of the fallopian tubes of the expectant mother is open and hysterosalpingography, that is, a film of the uterus with contrast should be taken to examine the uterus. In addition to HSG, thyroid function tests should be performed, the presence of infection should be questioned and a complete blood work should be performed. Evaluation of ovulation reserves is also extremely important.
Men also need to undergo a series of tests before IUI. One of the main criteria for the success of this treatment is the sperm quality of men. Semen analysis is needed, to obtain information about sperm quality. It is important to perform a sexual abstinence before semen analysis and to perform the test at least twice in different time periods in order to obtain the most accurate data.
In scientific studies, it has been shown that when women's age and body mass index values are in the ideal range, after the ovarian stimulation protocol is applied, the success rate of IUI treatment increases to 16.7% with a male with more than 9 million total motile sperm.4
Infertility is when women are unable to conceive despite having unprotected and regular sexual intercourse for at least 12 ovulatory periods. Intrauterine insemination (IUI) treatment, which is one of the assisted reproductive techniques applied to infertile couples to help them have a baby, may be preferred in the following cases:
If, during the diagnosis of infertility, according to the results of tests performed on both women and men, no physical cause preventing pregnancy is determined, this condition is called "unexplained infertility". Women diagnosed with unexplained infertility do not have a structural defect in their uterus. Ovulation is taking place, the fallopian tubes are open, the egg reserve is in good condition, and the hormone level is ideal. In men, there seems to be no problem with sperm quality. In the treatment of unexplained infertility, assisted reproductive techniques can be resorted to and IUI therapy can be initiated.5
Although there is a strong link between endometriosis and infertility, the mechanism behind this link is not precisely understood. Scientific studies show that the incidence of infertility among women diagnosed with endometriosis is between 30% and 50%.6 Although better results can be obtained in women with endometriosis with IVF treatment, IUI treatment may be preferred for women who experience mild and moderate endometriosis.
Sexual dysfunctions in men and women can prevent pregnancy. In case of advanced erectile dysfunction in men and/or presence of vaginismus in women, IUI treatment stands out as an effective assisted reproductive technique.
The cervix can be defined as the connection point between the vaginal canal and the uterus. During ovulation, the cervix secretes a special fluid that will facilitate the sperm to reach the egg. If this secretion is thicker than necessary, it may slow down the forward momentum of spermatozoa or the cervix may directly prevent the meeting of spermatozoa and eggs. Thanks to IUI therapy, the cervical factor that prevents the union of eggs and sperm can be eliminated.7
By washing the semen sample taken during the IUI treatment, sperm concentration is obtained and the highest quality, most motile sperms can be selected and injected into the uterus. In case of a slight decrease in sperm parameters, IUI therapy may be preferred.
Although single tube obstruction is not a reason that completely prevents pregnancy by natural means, it may still bring IUI treatment to the agenda. When the obstruction is close to the ovary, the success rate of IUI treatment is around 11.7%, while when the obstruction is close to the uterus, it can increase up to 38.1%.8
Successful results can be obtained with IUI treatment in women with ovulation problems. As the first stage, egg development is supported by stimulation of the eggs. Developing eggs is monitored with ultrasound and a the developing eggs are cracked so that they progress to the fallopian tubes for fertilization.
IUI is a simple and almost painless practice. Egg stimulant drug therapy can be applied before assisted reproductive treatment in the clinical environment. This treatment is optional.
In order for IUI treatment to be successful, ovulation must be monitored with precision. Specific changes occur in the female body during the process of ovulation.9 Cervical mucus secretion begins to increase, sexual desire may increase or decrease, the position and firmness of the cervix may change, basal body temperature rises, and ovulation pain also known as Mittelschmerz pain may manifest.
The main purpose of ovulation monitoring is to determine the optimal time for pregnancy. For the treatment of IUI, various methods can be applied to determine the time of ovulation of women. The most effective method is to follow up with a blood test or ultrasound.
One of the most important stages of IUI therapy is the preparation of spermatozoa. For this procedure, a semen sample is first taken from the man. Although it is usually done on the same day as the procedure, in some cases, semen can be collected before the day of the treatment. In this case, the prepared spermatozoa need to be frozen. The semen sample taken before is washed with special procedures. Sperms are separated from the other fluids that make up the semen and concentrated.10 The process is completed in about 2 hours. Thus, the injection of the highest quality and most mobile spermatozoa into the uterus can be ensured.
One or two days after ovulation occurs, the final stage of the treatment process is started. The procedure takes about 12-20 minutes. The injection of concentrated sperm into the uterus is completed in a few minutes.
During the procedure which resembles a Pap Smear test, women lie down in an examination position. A speculum is inserted into the vagina. Then, a long, thin and flexible catheter with a selected concentration of sperm at the tip is advanced from the cervix into the uterus. When in the uterus, the sperm concentration is released. The catheter is delicately withdrawn from the uterus and the procedure is terminated by removing the speculum.11
Immediately after the procedure, women need to rest for about half an hour. They can then return to their daily lives. The most common side effects after the procedure are mild spotting and cramping.
A pregnancy test can be performed about 2 weeks after treatment. If the pregnancy test gives a positive result, pregnancy symptoms may begin to manifest three weeks after the application.
Multiple factors are effective in the success of IUI treatment. It is known that especially if fertility drugs are used, the pregnancy rate may increase to 20%, but the success may vary according to the underlying cause of infertility. In addition to the cause of infertility, the age of the expectant mother also appears as an extremely important variable. Age remains to be an important factor in the quality of the egg and, consequently, in the formation of pregnancy. It is known that the male factor is also effective in the success of this treatment. Although the semen sample taken from men undergoes special procedures and the sperm concentration is obtained, their quality is decisive.
Although all the necessary conditions are met, pregnancy may not be achieved in the first attempt. IUI can be tried 2-3 times, and the number of attempts can reach up to 6. It is known that consecutive treatments will not create a medical problem. In the event that pregnancy cannot be achieved with this therapy, IVF treatment can be considered.
1 https://americanpregnancy.org/getting-pregnant/intrauterine-insemination/
2 https://www.msdmanuals.com/home/women-s-health-issues/infertility/assisted-reproductive-techniques?query=intrauterin%20insemination#v42282748
3 https://www.verywellfamily.com/what-is-iui-treatment-1960187
4 https://www.progress.org.uk/iui-success-is-dependant-on-motile-sperm-count-threshold/
5 https://my.clevelandclinic.org/health/diseases/23187-unexplained-infertility
6 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3538128/
7 https://www.mayoclinic.org/tests-procedures/intrauterine-insemination/about/pac-20384722
8 https://www.webmd.com/infertility-and-reproduction/what-is-iui-success
9 https://americanpregnancy.org/getting-pregnant/infertility/signs-of-ovulation/
10 https://www.nhs.uk/conditions/artificial-insemination/
11 https://www.mayoclinic.org/tests-procedures/intrauterine-insemination/about/pac-20384722
12 https://my.clevelandclinic.org/health/treatments/22456-iui-intrauterine-insemination
It is one of the assisting reproductive techniques applied to couples who cannot have a baby by natural means. It is also called artificial insemination. IUI is basically in the form of injecting the sperm concentration obtained as a result of washing the semen sample taken from the male into the uterus, 1-2 days after ovulation is detected. The main goal of treatment is to increase the likelihood of pregnancy.
IUI is an assisted reproductive technique that can be applied very easily, consisting of several simple aforementioned stages, which also requires careful follow-up of ovulation.
IUI treatment alone does not increase the likelihood of twin pregnancy. However, in women who have ovulation problems, the maturation of more than one egg with the use of egg stimulant drugs may bring up the possibility of multiple pregnancies. Multiple pregnancy is not a targeted outcome of IUI. Therefore, the follow-up of egg development with ultrasound is extremely important.
In IUI treatment, sperms are released directly into the uterus, while in IVF treatment, eggs collected from women are combined with sperm obtained from the semen samples taken from men, in the laboratory environment, and the embryo is formed outside the womb. Then, the highest quality embryos among the embryos obtained are transferred into the uterus. These are the main differences between the two assisted reproduction techniques.
For the optimal success rate of IUI treatment , it is assumed that the minimum total motile sperm count should be at least 6 – 7 million. Increasing the number of motile sperm increases the success rate of intrauterine insemination.1
1https://www.fertstert.org/article/S0015-0282(08)02172-9/fulltext
IUI treatment can be an option for the couples with male-induced infertility problems, women with ovulation disorders, women with obstruction in one of their tubes, women with mild endometriosis problems, couples diagnosed with unexplained infertility.
In the success of the intrauterine insemination method, the reasons behind infertility, the timing of treatment and the age of women are extremely important variables. As women age, the success rate decreases. As a result of the researches, it was determined that the average success rate of IUI treatment was 13% among women under 35 years of age, 10% among ages 35-37, 9% among ages 38-40, and 3%-9% among ages 40 and older.1
1https://www.webmd.com/infertility-and-reproduction/what-is-iui-success
When both fallopian tubes are obstructed, when the egg reserve is inadequate and the quality of the eggs are lackluster, when the number and motility of sperm is severely low, in the presence of advanced endometriosis, IUI treatment is not recommended.
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