Artificial Insemination : Intra uterine insemination (IUI) | iui Procedure :

IUI may be either AIH (artificial insemination husband) or AID (artificial insemination donor). Husband semen is commonly used.

 

 

 

 

 

 

Purpose:- To bypass the endocervical canal which is abnormal & to place increased concentration of motile sperm as close to the fallopian tubes.

Indications:-

• Hostile cervical mucus
• Cervical stenosis
• Oligo spermia or asthenospermia
• Immuno factor (male & female)
• Male factor – impotency or anatomical defect (hypospadiasis) but normal ejaculate can be obtained.
• Un explained  infertility.

Technique :-

                  Washing, centrifugation & swim- up methods are commonly used. About 0.3 ml of washed and concentrated sperm is injected through a flexible polyethylene catheter with in the uterine cavity around the time of ovulation.

ü  Swim – up method selects the motile spermatozoa. The processed motile sperm for insemination should be at least 1 million, if not more.

ü  Fertilization capacity for spermatozoa is for 24- 48 hrs.

ü  The procedure may be repeated 2-3 times over a period of 2-3 days .

ü  To increase sperm motility, pentoxyphylline (phosphodi esterase inhibitor) have been used. Generally 4-6 cycles insemination with super ovulation is advised.

Timing of IUI :-

                         In cervical insemination, timing is not so much vital because the sperm can survive in the canal for a day (or) two.

• As the reservoir   function is not available in IUI. Some form of controlled ovarian hyper stimulation (COH) is required.
• Spontaneous cycle (cervical mucus study & BBT chart).

                        IUI * 2, following 18 & 42 hrs of hcG administration.

 

RESULTS :- Widely varies in different centres. Ranging 20-40%,

• The best results are obtained in the treatment of cervical factor & un explained infertility & in stimulation cycle.
• IUI along with the super ovulation gives higher results.

Fallopian tube sperm perfusion :-

Technique :-

               Large volume of washed & processed sperm is injected with in the uterine cavity around the time of ovulation. This cause perfusion of the fallopian tubes with spermatozoa. In conjunction with ovulation induction pregnancy rate is 25-30% per cycle.

ARTIFICIAL (Therapeutic) INSEMINATION DONOR (AID).  

        When the semen of a donor is used for insemination. It is called therapeutic insemination donor.

The indications are:-

¨     Untreatable azoospermia, asthenospermia,

¨     Genetic disease

¨     Rh – ve donor insemination – for woman with Rh-ve sensitisation.

ᴥ   The donor should be healthy & of the same ethnic group as husband.

ᴥ   He should be serologically & bacteriologically free from venereal diseases including AIDS

   &hepatitis.

ᴥ     The recipient & donor must be matched for blood grouping &Rh typing. Either fresh (or) frozen semen is used.

ᴥ     The legal, psychological & religious aspects should be counselled before its application.

 

RESULTS :-

           A total of 3-6 cycles may have to be utilised to get a success. The success rate is about 50-60%.  insemination, when combined with super ovulation, enhances success rate.

. Two insemination, 18 & 42 hrs after hcG administration give higher results when compared to single insemination after 36 hrs.