Intrauterine insemination or IUI, as commonly known, can be considered as the first line of treatment for infertility. IUI can be useful for both male and/or female factor related infertility. Typically, indications for IUI include-
Oligoasthenoteratozoospermia i.e. men with low sperm count, or less motile sperm in the ejaculate, or having many abnormal sperm. In our experience we have found that if the total motile sperm concentration after sperm wash is less than 5 millions then the success rate is less.
Sexual or ejaculatory dysfunction where semen is collected using vibrator or through electro ejaculation.
Retrograde ejaculation, where semen enters the bladder after orgasm, instead of ejaculating out through penis.
Immunological factors like autoantibodies and sperm agglutination.
Men with highly viscous semen for prolong time, which restricts sperm movement deposited in the cervix under natural circumstances.
Donor sperm insemination
Decreased libido due to drug intake ,smoking,chewing tobacco,diabetis and other medical conditions
Anatomical defects of male reproductive tract like hypospadiasis
Serodiscordent couple with HIV positive husband
Anatomical defects of the reproductive tract, where direct coitus is not possible
Psychological sexual dysfunction – dysparuenia, vaginismus.
Cervical factors i.e. poor sperm-mucus interaction, failed post-coital test, antisperm antibodies.
It has been universally observed that whenever IUI is combined with induction of ovulation or controlled ovarian stimulation, the success rate in the form of pregnancy is improved.
Depositing actively motile sperm free from debris, leucocytes, pus cells, and dead sperm has a significant reproductive advantage in fertilizing the released oocyte from the ovary, in the fallopian tube. During natural intercourse, semen is deposited in the vagina, motile sperm from the semen move towards fallopian tube. Out of around 100 million sperm from a ‘normal’ man deposited in the vagina, only about 1 million sperm find their way to the upper portion of the uterine cavity and only few hundred enter the tube where fertilization occurs. In IUI, 5-10 million motile sperm are deposited at the top of the uterine cavity near the opening of the tubes thus significantly increasing the chances of healthy sperm reaching the mature oocyte.
The risk of infection with IUI is very small if properly done in a good centre having proper facilities for sperm processing .
In 1978, PC Steptoe and RG Edwards successfully ‘created’ human embryo out side the body after fertilizing female gamete – the oocyte using male gamete- the sperm in a test tube. Though the patient underwent this treatment had blocked fallopian tubes, subsequently clinicians found that many other indications can be effectively treated by this innovative treatment modality.
Over the past 30 years, In Vitro Fertilization has seen many changes that include continuous refinement techniques, development of patient selection criteria, and patient preparation.