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I.U.I (INTRAUTERINE INSEMINATION)
It is a basic step towards fertility treatments. It is also called artificial insemination. This fertility treatment can be done using partner's sperm or sperms from donor. The woman is given some medications for stimulation. On the other hand semen is collected, washed with special chemical and then the healthy and motile sperms are separated. Then these are injected into the uterus on ovulation day. It is a successful method. |
| Request for Assisted Reproductive Techniques |
Infertility affects 15 to 20 % of couples who are attempting conception. The initial diagnostic and therapeutic steps may halt or reverse a pathologic process that is detrimental to fertility, resulting in relative subfertility. In such situations it may be necessary to resort to assisted reproductive techniques (ART), which include intrauterine insemination (IUI) with processed semen and in vitro fertilization with embryo transfer (IVF-ET). |
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| A. |
ART IS INDICATED in selected cases of the following conditions:
- Endometriosis
- Unexplained infertility
- Cervical factor in infertility
- Male factor in infertility
- Tubal factor in infertility
- Immunologic factor in infertility
- Genetic error
- Religious factor
- After correction of anatomic defects
- Rh-isoimmunization
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| B. |
PREREQUISITES FOR IUI are as follows:
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At least one tube should be patent and functionally normal.
- Ovarian and uterine factors should be normal.
The patient is kept in lithotomy position. A bivalve speculum is introduced into the vagina to visualize the cervix. The cervical canal is cleaned with a swab moistened with normal saline. The processed semen is injected into the uterine cavity with the help of IUI cannula. The patient is kept in supine position for half an hour. Luteal phase support is given. If the patient does not conceive after 3 cycles, reevaluation is done for other causes of infertility. If the tests are inadequate or the results ambiguous, they are completed or repeated. Any abnormality present is corrected. The patient is then subjected to 3 more cycles of IUI. If she fails to conceive, evaluation is done for IVF. |
| C. |
PREREQUISITES FOR IVF are as follows:
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Hysteroscopy and laparoscopy are done to confirm indications, accessibility of the ovaries, and the status of the fallopian tubes.
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Vaginal and cervical infections, if any, are treated.
- Semen analysis is done on 3 occasions to exclude error due to variability between samples.
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Psychological counseling is done with respect to fear of infertility, the demanding schedule of IVF, cost, success rates and the risks involved. Emotional support is also required when an IVF cycle fails, to help cope with the stress.
- HIV screening is done in view of the increased incidence of sexually transmitted diseases.
Apart from the routine evaluation for infertility, a patient undergoing ART (expect IUI) requires vigorous and specific monitoring of the hormonal pattern of a menstrual cycle, so as to pinpoint the various difficulties likely to be encountered during the stimulation and / or treatment cycle. The following investigations are done in the cycle preceding the IVF cycle.
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Hormonal assays on day 2 or 3 of the menstrual cycle: serum FSH, LH, estradiol, prolactin, T3, T4, TSH, testosterone, ketosteroids.
- Pelvic ultrasonography: to rule out ovarian cysts, uterine leiomyomas etc.
- Semen analysis (see before)
- Cervical culture: on day 7 of the menstrual cycle.
- Reassessment of the uterine and tubal factors.
- Serial ultrasonography for follicular monitoring and ovulation.
- Serum progesterone level on seventh postovulatory day to detect luteal phase defect (day 21, 22)
This preliminary work-up helps to select the patient for proper ovulation induction and luteal phase support, so as to improve the success rate. |
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