Many couples have difficulty in conceiving. The emotional suffering and despair which childlessness may bring to an otherwise fulfilling relationship is substantial. Couples who are unable to conceive turn to their physician for advice and guidance and may need referral to a subspecialist for very sophisticated treatment.
The choice of one particular procedure will depend on the type (or cause) of infertility which investigations reveal. This booklet tells you more about intrauterine insemination (IUI) which is just one of several treatment techniques which may be recommended.
THE SCALE OF THE PROBLEM
Intrauterine insemination may be considered for couples thought suitable. Usually, IUI will only be performed in couples whose infertility investigation has failed to detect a specific cause of infertility and who have been trying for a baby for at least two years. This technique should not be undertaken until a thorough investigation has been performed to try and determine the reason for the inability to conceive.
ASSESSING THE CAUSES
The tests required to determine a specific cause of infertility will assess ovulation, the quality of the fallopian tubes (by laparoscope and/or hysterosalpingogram), and hormone levels in women and sperm production (numbers, movement, and shape) in men. Following intercourse, only a small number of the sperm ascend the female genital tract. The goal of IUI is to increase the number of sperm at the site of fertilization in the fallopian tubes.
The objective of IUI is to introduce a quantity of sperm into the female partner's uterus, and thereby encourage fertilization.
WHICH COUPLES BENEFIT?
IUI is also effective in women with ovulatory disorders, provided they respond adequately to fertility drugs. In such cases ovulation is stimulated by a course of hormone treatment, such that intrauterine insemination is timed to take place shortly after the day of ovulation. Indeed, this technique of stimulating ovulation with hormones and introducing the sperm (commonly referred to as "washed sperm") just after ovulation has proven very effective in a variety of cases and is now the preferred method in couples with or without ovulatory disorder.
Because IUI relies on the natural ability of sperm to fertilize an egg within the reproductive tract, it is important that tests for male infertility indicate reasonable sperm function (numbers, movement, and shape).
There has been some success with IUI in cases where the female partner has endometriosis in the absence of mechanical distortion of the pelvic structures. This is a very common disorder, particularly in women in their thirties who have had no children, and may be associated with as many as one-in-four cases of infertility. The condition occurs when tissue from the womb lining (endometrium) is spilled through the fallopian tubes, into the pelvis, and implants on the surface of the pelvic cavity and often the ovaries. Women with mild endometriosis are usually treated similarly to women with unexplained infertility.
Studies show that IUI will not be effective in cases where the male has low sperm counts or poor sperm shape. Similarly, women with severely damaged or blocked tubes will not be helped by IUI.
HOW THE TECHNIQUE WORKS
Because fertility drugs can produce several eggs, monitoring is important during this drug treatment phase in order to ensure that any side effects of treatment and/or the risk of multiple pregnancy are reduced. Monitoring of treatment is carried out by measuring estrogen concentrations in blood samples, and by tracking the development of follicles by ultrasound. If too many follicles develop, too many eggs may be released and thus, increase the risk of multiple pregnancy. Therefore, the usual aim in IUI is to generate at most two to three eggs. (Superovulation and IUI differs from IVF in that the former aims to stimulate just one dominant follicle, while the latter aims to produce as many eggs as possible for laboratory fertilization).
When two or three follicles have reached their target size, ovulation is induced with a further hormone injection (hCG). Then, shortly after the time of ovulation, a sample of fresh semen is collected by the male, washed, inserted through the cervix and placed high into the uterus of the female partner through a fine catheter. This is a quite painless procedure, comparable to a Pap test.
STEP BY STEP IUI TREATMENT
New "micromanipulation" techniques of treating these difficult cases of male infertility are considered very exciting. One of these microtechniques, known as intracytoplasmic sperm injection (ICSI), allows doctors to inject a single sperm into the center of an egg to bring about fertilization. The success of this technique seems likely to make TDI less frequently used. IUI as a treatment differs from AID or TDI in that the male partner has better quality sperm and usually provides his own sample. The treatment, therefore, poses none of the emotional difficulties of AID or TDI, because no third party is involved.
THE RISKS OF TREATMENT
THE CHANCE OF SUCCESS
Doctors might try four cycles of IUI and if these are not successful, then recommend other methods like IVF or GIFT. Unlike IVF or GIFT IUI involves no difficult egg collection or general anesthetic and is currently a popular and quite successful treatment method of infertility.
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