IUI has been an option for couples who struggle with conceiving. But like any potential solution, it comes with factors that require consideration. So, we’re laying down the facts to give you a heads-up on what to expect from this procedure.
So, if you’re interested in a consultation for IUI soon, here’s what you need to know.
What is IUI?
Intrauterine Insemination is the first line of defense for couples who face difficulty in conceiving. Also referred to as donor insemination or alternative insemination, it is done by placing the sperm in the uterus around the time you’re ovulating.
The Facts of the Matter
IUI is a relatively simple treatment. But like any other, it requires commitment and a full understanding of the procedure. This allows you to weigh its strengths and drawbacks for you to make an an informed decision. So, let’s start with the basics.
To ensure a safe process, you and your partner must first undergo a battery of tests. This will include the following:
- Normal Pap smear in the past year
- Hepatitis B, C, HIV, syphilis (VDRL), Rubella Ig G testing
- Blood type and screen
- Ultrasound scan to determine the size and number of eggs inside each ovary and to exclude abnormalities that may hinder implantation
- Men providing a semen specimen must be tested for infectious diseases like HIV, syphilis, hepatitis B and C
- Fallopian tube patency check eg Hysterosalpingogram
- +/- Cervical swab cultures for chlamydia and gonorrhea
IUI starts by obtaining the sperm from the male partner or donor. The sperm is then counted, washed, and concentrated before it is placed in a small syringe.
Semen analysis is important to the IUI process to accurately diagnose male infertility. This will involve sperm count and observation of sperm motility and morphology (shape). These semen parameters will assess quality, and its results will help predict IUI outcome. The normal semen parameters according to the World Health Organisation reference ranges are as follows:
- Volume of Semen: More than 1.5 ml
- Sperm Concentration: More than 15 million sperms per ml
- Sperm Motility: More than 40%, 32% forward progression
- Sperm Morphology: More than 4% has a normal shape
- White Blood Cells: less than 1 million per ml
Sperm Washing, also called sperm preparation or spinning, is the process of preparing the sperm sample before it is inseminated. It involves techniques to separate the sperm cells from other supporting fluid or cells. It also separates the motile sperm from non-motile ones. This process is done also to enhance the quality of the initial sperm sample.
Centrifugation follows once the appropriate washing medium has been mixed. A centrifuge is a machine the spins at a high speed to separate materials of different densities. From this, the sperm-rich fraction is obtained and loaded into a syringe.
To aid in the insemination process, a very small flexible catheter or tube is attached to the syringe. It is then inserted through the cervix and into the lower part of the uterus to deposit the sperm directly.
What it Feels Like
IUI involves the use of the speculum to properly visualize the cervix, similar to having a pap smear. It may create a slight discomfort, but it is not painful. However, IUI itself is reported to be painless because it only uses a small and flexible catheter.
- Women with minimal or mild endometriosis
- Mild male sperm abnormality
- Unexplained infertility
- Unsuccessful fertility treatments with medications alone
- Couples with dual factor abnormalities eg ovulation and sperm abnormalities
- Couples with abnormal mucus (IUI can bypass possible cervical factors)
- If sperm donor is used
- Couples who are unable to have vaginal intercourse due to reasons like physical disability or psychosexual problem
- Severe endometriosis
- Previous pelvic infection
- Blocked fallopian tubes
- Cervical atresia (a condition where the cervix is abnormally absent)
Time and commitment are needed since the process involves several trips to the clinic.
The Heart of the Matter
The process itself may be reasonably straightforward, but the entire journey can take a lot from a woman or a couple who puts their efforts, emotions, and resources into it.
Time and commitment are needed since the process involves several trips to the clinic. You must follow this through very carefully as there is only a small margin of error that could put you off your schedule when timing your fertile period. It can be distressing for women when a cycle has been abandoned due to extraneous factors like work and conflicts in schedules.
What may also be frustrating to some is when they don’t ovulate in time which causes them to miss certain months. These instances are unavoidable since our bodies react to treatments differently. Furthermore, women who use medicines to stimulate the ovaries might also have to contend with unpleasant side effects.
The reality is that these are just some of the challenges which can test your resilience throughout the process. The preparation, the waiting, and sometimes unsuccessful results can take a toll on your resolve. However, it is important to remember that you can always find help and support.
First, your doctor is there to advise you on your next course of action. Therefore, finding a clinic you trust and a practitioner who understands your goals is important. You can also find a community online where you can reach out to others who are on the same journey as you. These support groups are not only good avenues where you can find emotional support, but also one where you can learn from the experience of others.
IUI Success Rate
Success rates vary depending on different factors, such as:
A woman’s age – IUI success rate is higher in younger women, but it starts to decline after the age of 35.
Timing – If the timing of ovulation is not detected properly, the time of insemination may not be synchronized with the peak period of fertility within your cycle.
Fertility drugs – You are more likely to get pregnant if you take fertility drugs that can help stimulate your natural cycle. You can ask your doctor about them and how they can improve your odds of getting pregnant with IUI.
The status of a woman’s fallopian tubes – A woman interested in IUI should have at least one open unblocked fallopian tube.
The quality of the sperm sample – IUI is generally less successful in men with very low sperm counts or poor motility– less than 2 million total motile sperm of normal forms. Sperm motility is the ability of the sperm to move or swim efficiently.
The number of IUI cycles – Most women will have several cycles of IUI before they can conceive. This is also something to consider when you’re thinking about the costs of the treatment.
The couple’s general health condition – Couple must strive to improve their health as much as possible to maximize the success rate of fertility treatment with IUI. A healthy diet and lifestyle is important and chronic conditions like diabetes should be under control prior to treatment.
How Many Times Should You Do IUI?
Since IVF (In Vitro Fertilization) is an expensive option, IUI is often the first treatment suggested to those who wish to conceive. It is also less invasive and less demanding. But what should you do if you are still unable to get pregnant after several rounds of IUI? How many times should you try before moving on to the next option?
Some women are lucky enough to get pregnant after their first attempt, while others succeed after a number of tries. For this, doctors advise patients who are under 35 to try 3-6 cycles of IUI before trying IVF. Women above 35 may be recommended differently since fertility decreases at this age thereby reducing the chances of conceiving through IUI.
The process behind IUI may be a personal journey but it is best that you talk with your doctor and partner regarding your next step. It helps when you understand your limits and when it is still worth another try.
IUI may be less costly than IVF, but couples who go through it would still have to consider the cost. IUI, for instance, may require more than one cycle. In singapore, MediSave for Assisted Conception Procedures (ACP) is a government subsidy to help defray the costs of procedures like IUI and IVF.
You can learn more about it, here.
The IUI journey may not be a walk in the park, but it pays to have the right knowledge, preparation and any manner of support. If you think IUI is an option you and your partner are willing to try, you can book a consultation with Dr. Pamela Tan today for a more in-depth discussion.
Dr Pamela Tan is a board certified obstetrician and gynecologist in Singapore. She finished her undergraduate studies at the National University of Singapore and earned her post-graduate degree at the Royal College of Obstetricians and Gynaecologists in the UK. She is an accredited specialist by the Specialist Accreditation Board (Ministry of Health), and a fellow of the Academy of Medicine, Singapore. She subspecialises in colposcopy and is certified to perform Level 3 minimally invasive keyhole surgeries such as laparoscopic hysterectomy, myomectomy and cystectomy. Dr Pam also supports the natural birthing method and she strives to provide a personalised care and treatment for each patient.