Intrauterine insemination – Клініка Стефана Хміля

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Intrauterine insemination

Intrauterine insemination is one of the ways of assisted reproductive technologies. Although this procedure is included in artificial methods of conception, it is still a method that is close to natural insemination. The prepared sperm of a man is transfered into the uterus through a special catheter made of hypoallergenic, soft materials. Probably this is only one “unnatural” moment in the whole procedure. Then everything happens as usual – active sperms through the fallopian tubes get to the egg cell, meet with it and there is a fertilization process.

The procedure can be performed both in the natural menstrual cycle and with the use of superovulation inductors. It should be noted that the incidence of pregnancy in the natural cycle is lower than in the stimulated. Conducting insemination in combination with medications that stimulate the maturation of the follicles, increases the incidence of pregnancy. Often, the following medications are used for stimulation: Clomifene, Follitropin beta, human menopausal gonadotropin – Menopur, Follitropin alfa or other. Chorionic gonadotrophin is also used, which helps the mature follicle to mature and exit the egg cell. When using medications to stimulate ovulation, the onset of ovarian hyperstimulation syndrome (OHSS) is unlikely, since the dose of the medication is very low.

Indications to IUI involving the husband’s sperm

Male causes for IUI by husband’s sperm:

  sperm subfertility;
  ejaculatory and sexual disorders;
  retrograde ejaculation;
  oligospermia (refers to semen with a low concentration of sperm);
  high viscosity of sperm;
  cryopreserved sperm;
  presence of antisperm antibodies;
  after chemotherapy treatment or vasectomy.

Female causes for IUI by husband’s sperm:

  unexplained infertility;
  cervical factor of infertility (chronic endocervicitis and other);
  manipulations on the cervix in anamnesis (conisation, amputation, diathermy, cryotherapy and other);
  presence of antispermal antibodies;
  ovulatory dysfunction that can be treated;
  Sperm allergy;

 Indications to IUI involving the donated sperm

Male causes for IUI by donor sperm:

  absence of spermatozoa in ejaculate;
  ejaculatory and sexual disorders;
   unfavorable medicogenetic prognosis;

 Female causes for IUI by donor sperm:

  absence of sexual partner.

Intrauterine insemination can be provided by the sperm of the partner or donor. In the case of IUI involving donated sperm, only cryopreserved sperm may be used. The use of this sperm is only possible after receiving the repeated (in 6 months after sperm handing over) negative results of the analyzes of HIV, syphilis and hepatitis. The use of frozen / unfrozen sperm allows to provide:

  the realization of prophylactic measures against the transmission of HIV, syphilis, hepatitis and other infections;
  the exception of the possibility of a donor and recipient meeting.

Contraindications for IUI for the woman:

  more than 40 years;
  somatic and mental diseases when pregnancy is contraindicated;
  uterine malformations or pathologies;
  tumours in the ovaries;
  malignant tumours of any localization;
  pathology of fallopian tubes;
  infection of genital tract;
  vaginal bleeding of unknown origin;
  operative procedures in the cavity of small pelvis in anamnesis;
  plural unsuccessful attempts of IUI (four and more);
  luteinization of non-ovulating follicle in two successive cycles;
  ovarian hyperstimulation syndrome (OHSS) in anamnesis;
  acute inflammatory diseases of any localization.

Possible complications:

♦ allergic reactions associated with the administration of medications for ovulation stimulation;
♦  shock reaction when sperm is injected into the uterine cavity;
♦ increase tone of the uterus;
♦ ovarian hyperstimulation syndrome (OHSS);
♦ acute inflammation or exacerbation of chronic inflammation of the female genital organs;
♦ the appearance of multiple pregnancies and / or ectopic pregnancies.

Examination of couple before the IUI

For a woman it is obligatory:

♦ general and special gynecological examination;
♦ test for microflora from the cervical canal;
♦ cytological examination of cervicx;
♦ ultrasound examination of the pelvic organs;
♦ conclusion with a therapeutist;
♦ blood group test and Rh factor;
♦ Clinical blood test, including coagulation time (valid for 1 month);
♦ blood test for syphilis, HIV infection, hepatitis B and C (valid for 3 months);♦ blood tests on FSH, LH, AMH, estradiol, prolactin, testosterone, cortisol, progesterone, T3, T4, TSH;
♦ infectious analysis (chlamydia, uro- and mycoplasmosis, herpes virus, cytomegaly, toxoplasmosis, rubella).

For a man it is obligatory:

♦ blood test for syphilis, HIV, hepatitis B and C (valid for 3 months);
♦ spermogram;
♦ blood group test and Rh factor;
♦ infectious analysis (chlamydia, uro-mycoplasmosis, herpes simplex virus, cytomegaly).

Also, for a married couple older than 35 years old, a genetic consultation is required.

The probability of pregnancy following intrauterine insemination (IUI) depends on many factors: the age of the woman, the duration of infertility, the quality of sperm, the results of the analysis, as well as the number of previous inseminations. The chances of getting pregnant are 10-15% for every attempt.

It is recommended to do no more than 3-4 attempts of insemination. This is due to the fact that 87% of patients who have a pregnancy as a result of insemination, are pregnant in the first 3 cycles of insemination. In other women, the probability of pregnancy during further insemination does not exceed 6% per one attempt. Therefore, after ineffectiveness of 3-4 attempts of insemination we proceed the procedure in vіtro.

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