Q. What is Intra Uterine Insemination or IUI ?
A. IUI is the depositing of washed motile sperm into uterine cavity using a fire plastic catheter , through cervix, IUI is a first step, cost-effective method to enhance the fertility in a woman with patent fallopian tube.
Q. How long sperm servives after timed intercourse of IUI ?
A. Normal healthy sperms survive 48-72 hours. Washed sperm for IUI or IVF survives ~72-80 hours in Co2 incubator.
Q. How long does it take for Fertilization and for implantation ?
A. Fertilization occurs within 24 hrs after ovulation while implantation takes about 5-10 days after ovulation.
Q. What is a ideal value for estrogen during the IUI cycle with injectables ?
A. From our experience estrogen should be around 150-200 per mature follicle. It might little vary as per individual and as per injectables like for example if a woman is an injectable with LH-than estrogen level may be 100 or over after 3 days of injectibles , while for recombinant FSH, estrogen value should be low after 4-5 days of injectables.
Q. What is an ideal range for uterine lining at the time of IUI ?
A. At LH surge level, uterine lining should be between 8 to 12 mm. The triple lining occurs at the time of implantation.
Q. What will be the ideal size of leading follicle before the hCG shot ? & how much do follicle grow each day ?
A. Follicles grow 1 to 2 mm a day while taking ovarian stimulation drugs and once the leading follicle is ~ 19mm it is ready for hCG shot.
Q. Do smaller follicle also “match” with leading follicle at the time of egg release ?
A. Generally 15-16 mm size follicles contain fertilizable eggs. If the smaller follicles are of 15-16 mm size, it might release a mature egg, otherwise, it is most likely that only leading follicles will ovulate and release a mature egg.
Q. What is a maximum dosage for Clomiphene Citrate [C.C] ?
A. Maximum dose for CC is 150-200. It is advisable to move on injectables if there is no response with this dosage, as the risk for antiestrogenic side effects of CC increases sharply on the dosage goes up.
Q. What will be the ideal abstinence period for a couple before an IUI cycle ?
A. 3-4 days gap is ideal for a man. More than 4-5 days old. Sample may have a risk of poor motility, white cells and other problems.
Q. Explain me IUI procedure in brief ?
A. Medicine protocol for IUI is
- Clomiphene Citrate from period day 3- 7.
- Add injectables if required
- Follicular growth monitoring from the day 11 of cycle
- Monitoring of LH surge and estrogen level during the cycle
- Once the leading follicle reaches 19-20 mm size a slot of hCG.
- IUI performed after 36-40 hrs of hCG
- Adjustments in the ovulation induction protocol can be made as per individual need.
Q. What precaution lady should take during an IUI cycle ?
A. Before an IUI cycle, avoid heavy exercise, jogging or high impact aerobics.
Little rest just after the IUI procedure is advisable. For little pain a simple pain killer like Ibuprofen can be taken.
Q. What is the difference between super ovulation timing of coitus, IUI & IVF ?
A. SO-TOC is a first line of treatment of infertility. Either in SO-TOC or IUI the aim is to ovulate 3-4 eggs, while for IVF aim is to ovulate atleast more than 10 eggs. For SO-TOC and IUI monitoring of cycle is similar. Till hCG slot the procedure is same. SO-TOC couple will have intercourse while for IUI, insemination is done after 36 hrs of hCG slot. For IVF procedure please refer to page IVF.
Q. What time is better for taking injectables for an IUI cycle ?
A. For single injection, it is better to take in the evening so that if necessary dose can be adjusted after morning ultrasound follicular monitoring. It is not very critical, but one can fix some time in evening. However , hCG injection time is critical because on that basis IUI or IVF will be planned.
Q. What are the pre IUI treatment steps ?
A. Prior to IUI, women must have atleast one documented open fallopian tube as demonstrated by hysterosalpingogram or the tubal dye study. Beside that the blood test for hormone FSH is done on cycle day 3. Semen analysis is done for the male partner. Common tests which is for men and woman are blood grouping, blood test for sexually transmitted diseases, for HBsAg, antisperm antibody test and post coital test is a requirement before an IUI cycle.
Q. what is “washed” sperm ?
A. In nature, during intercourse sperm are deposited in the vagina and then they have to swim through the cervical mucus. In IUI method, as cervix is by passed there are many sperm available at the site of fertilization. As sperm are placed in uterine cavity, they have to be washed first, to get rid of any dead cells, bacteria and seminal fluid. There are different method for the washing of sperm which takes around 1 hour , so it is always advisable to produce semen before 1½ hour of scheduled IUI.
Q. If a partner is not available at IUI procedure time, what is the method for sperm freezing ?
A. One can freeze the semen sample before an IUI procedure if they are physically away at the time of procedure or if they cannot produce the semen sample on demand. Before semen freezing a complete blood work is done to rule out the possibility of HBsAg, HIV or gonorrhea. Then semen sample has to be produce by masturbation into sterile container provided by lab. Once given to the lab a complete semen analysis is performed which includes, volume, liquefaction and viscosity, sperm count, motility, forward progression and morphology. After that semen is subjected to freeze can be revived on IUI day.
Q. How long one can store the frozen sperm ?
A. The length of time that frozen sperm remain viable will vary from patient to patient. There have been normal pregnancies from sperm stored for over 20 years. Each individuals sperm react differently to the freezing process. The result of the post thaw analysis can give some indicating of how sperm cells react to the freezing process.
Q. Can using of frozen sperm increase the likelihood having a child with birth defects ?
A. All available data indicates that frozen semen does not increase the risk of birth defects. In fact, the freezing process tends to kill off weaker sperm, and may thus lead to survival of best sperm.
Q. What is donor IUI ?
A. Single women, couple with male partner has no sperm or very poor semen analysis and cannot afford expensive treatment like ICSI, donor IUI is an option. Some time, it is also used when there is an inheritable genetic problem which could be transferred from the male.
Q. How does IUI increase the chance of pregnancy ?
A. IUI procedure works by concentrating the healthiest sperm in the ejaculate and placing the washed sperm into the uterus adjacent to the fallopian tube. This bypasses any potential cervical factor problems and removes the sperm that are less likely to fertilize the egg.
Q.When is IUI used ?
A. IUI is a fertility treatment often selected by the couple, with atleast one patent fallopian tube and who have been trying to conceive for atleast one year. IUI also be selected as a fertility treatment with any one of the following conditions.
- low sperm count
- decreased sperm motility
- A hostile cervical condition [too thick cervical mucus]
- sexual dysfunction.
Q. How one can decide about fertility drug in conjunction with IUI ?
A. For use of fertility drug, a fertility specialist under whom couple is undergoing treatment can make the decision. In general, fertility drugs enhances a woman’s ability to become pregnancy with IUI. Most widely used medicine is clomiphene citrate either alone or with combination of injectables. Injectable fertility drugs that are more aggressive in stimulating multiple egg release. The more eggs that a woman produces during a treatment , the higher the chance for success.