IUI stands for intrauterine insemination and involves depositing sperm into a woman's uterus in the hopes of facilitating conception. It is the commonest used method of artificial insemination. It is a simple and safe treatment modality in infertility aimed at overcoming the natural barriers to the passage of the sperms from the vagina to the fallopian tubes. During IUI, a prepared semen sample with adequate numbers of motile, normal sperms suspended in a nutrient medium are directly placed in the uterine cavity, thus bypassing the need for sperms to travel from the vagina to the uterus. This is done around the predicted time of ovulation.

Indications for IUI
IUI is advised for certain indications:
•	Impaired semen quality , where the semen sample has low counts or motility
•	Sexual problems in the male like impotence or premature ejaculation.
•	Conditions where the cervix is hostile and thereby destroys the sperms, as evidenced by certain tests.
•	Unexplained infertility where all tests for infertility in the male and female are normal, yet the woman is unable to conceive.

A comprehensive history is taken and the required investigations are performed. Prior to undertaking treatment with IUI certain things need to be ensured.

IUI is performed at the time of ovulation in a natural menstrual cycle or in a cycle where the ovaries have been stimulated by certain drugs. Ovulation induction or stimulation of the ovaries, is the administration of certain drugs which act on the ovaries and stimulate them to produce more eggs, thus improving the chances of conception. The woman is asked to attend the clinic on the 2nd day of her menstrual cycle. After an ultrasound examination to check her uterus and ovaries she is prescribed medication to stimulate her ovaries. Such drugs are administered to ensure that the ovaries produce more than one egg to improve chances of conceptions. These can be in the form of oral medication or as injections which may have to be taken daily or on alternate days.

A very important part of the IUI treatment cycle is making sure that the insemination is done at the time of ovulation. In order to ensure this and to monitor that the ovary is responding well to the given drugs an ultrasound scan is performed usually on the 8th or 9th day of the cycle after the day 2 scan . Depending on the growth of the follicles (structures in the ovary containing the eggs) the scans are repeated till the right size is reached . The woman may then be advised to take an injection to help release the egg from the follicle or one can wait for it to get released on its own. At the predicted time of ovulation intrauterine insemination is carried out.

In general, it is usually recommended to do IUI just before ovulation is set to take place. Six hours is often the time frame given as washed sperm doesn't live much beyond six to 12 hours. Cycles using a single IUI are normally done 36 hours after the surge is detected or 36 hours after an hCG injection when a trigger for ovulation is given, while those having two IUIs done will be inseminated between 24 and 48 hours after the surge/hcg injection. There may be a slightly increased chance of pregnancy with two IUIs, but the difference is not statistically significant.

Abstinence is to be observed 2-4 days prior to the procedure. On the day of the insemination the husband gives a semen sample in a wide-mouthed sterile container provided by the Clinic. The sample should be obtained by masturbation and not coitus interuptus. Semen can be collected either at home, if you live close to the centre, or at IVF-Pune unit itself. Facilities ensuring privacy are available at the Clinic for this purpose. If you plan on collecting the semen sample at home , then this sample needs to be delivered to the clinic within an half hour of ejaculation. This is when a fresh sample is being used to perform the IUI . In case the husband cannot be present around the time of ovulation a sample can be frozen and frozen sperms can also be used to perform IUI. When donor semen samples are used , these are always frozen samples
After the specimen has been given for processing, the couple can leave and return for the insemination 1 -2 hours later as it would take this time approximately to prepare the sample.

Sperm washing must occur before IUI can happen. There are various ways in which sperm is prepared prior to IUI. The decision about which method of preparation is to be done is taken based on the quality of the semen sample as regards the volume, count and motility of the sperms. This process of sperm preparation can take anywhere from 45 minutes with simple sperm wash to one and a half hours with the swim up technique. Preparing the sample, in essence, refines and concentrates the sperms and enhances the fertilizing capacity of the semen specimen. Only motile normal sperms are obtained thereby eliminating all other contents. The sperms are suspended in a nutrient medium and this sample is used for insemination. Insemination should occur shortly after the sperm has been prepared.

The success rates of IUI depends on a number of factors. IUIs done with fertility drugs that produce multiple eggs have higher success rates compared to natural cycle IUI. Additionally, sperm count greatly affects the outcome with IUI. Using sperm samples with a smaller count often cause a couple to have less success. Overall, though, a success rate of 12-15% with each IUI cycle can be expected.
Like IVF, a few cycles of IUI may be necessary before you are successful. Generally no more than 4-6 cycles of IUI are tried. If you fail to have any results after trying a few cycles with both Clomid and injectable fertility drugs, you may want to consider trying IVF.

This is some background information on intrauterine insemination and we hope you find this informative. If you have any further queries please approach the front desk to schedule an appointment with one of our doctors. We would be happy to be of assistance.