{"id":2789,"date":"2023-10-23T21:34:05","date_gmt":"2023-10-23T11:34:05","guid":{"rendered":"https:\/\/www.drseragyoussif.com.au\/?page_id=2789"},"modified":"2025-01-16T05:22:18","modified_gmt":"2025-01-15T19:22:18","slug":"intrauterine-insemination","status":"publish","type":"page","link":"https:\/\/www.drseragyoussif.com.au\/?page_id=2789","title":{"rendered":"Intrauterine Insemination IUI"},"content":{"rendered":"
\n
\n
\n
\n
<\/div>\n<\/div>\n
\n
\n
\n
\n

Intrauterine Insemination IUI<\/span><\/h2>\n<\/div>\n<\/div>\n<\/div>\n
\n
\n
<\/div>\n<\/div>\n
\n
<\/div>\n
\n
\n
<\/div>\n
\n
\n
\n
\n
<\/span><\/div>\n<\/div>\n<\/div>\n<\/div>\n
\n
\n
\n

Definition<\/strong><\/h4>\n<\/div>\n<\/div>\n<\/div>\n
\n
\n
\n

Sperm are inserted into the uterine cavity around the time of ovulation.<\/span><\/p>\n

IUI can be done in<\/span><\/p>\n

 <\/span><\/p>\n

    \n
  1. A natural cycle<\/span><\/li>\n
  2. Stimulated Cycle<\/span><\/li>\n<\/ol>\n

     <\/span><\/p>\n

    The ovaries are stimulated with<\/strong><\/p>\n

      \n
    • Antioestrogens: a course of tablets for 5 days<\/span><\/li>\n
    • Gonadotrophins: a course fertility injections every day for 6 to 9 days or longer<\/span><\/li>\n<\/ul>\n

       <\/span><\/p>\n

      Ovarian response is monitored by vaginal ultrasound.<\/span><\/p>\n

       <\/span><\/p>\n

      Human Chorionic Gonadotrophin injection is given to trigger ovulation; when one to three ovarian follicles are seen to have developed to the required size, usually with one dominate follicle.<\/span><\/p>\n

       <\/span><\/p>\n

      Prepared sperm is inseminated 24 to 36 hours later. Insemination may be withheld if 2 or more mature follicles are seen to reduce the risk of multiple pregnancies.<\/span><\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n

      \n
      <\/div>\n
      \n
      \n
      <\/div>\n
      \n
      \n
      \n
      \n
      <\/span><\/div>\n<\/div>\n<\/div>\n<\/div>\n
      \n
      \n
      \n

      IUI has been used in:<\/em><\/strong><\/h4>\n<\/div>\n<\/div>\n<\/div>\n
      \n
      \n
      \n
        \n
      • Unexplained infertility<\/span><\/li>\n
      • Mild endometriosis<\/span><\/li>\n
      • Mild male-factor infertility<\/span><\/li>\n
      • Disability (physical or psychological) preventing vaginal sexual intercourse<\/span><\/li>\n
      • After sperm washing in a couple where the male is HIV positive<\/span><\/li>\n
      • Donor insemination<\/span><\/li>\n<\/ul>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n
        \n
        <\/div>\n
        \n
        \n
        \n
        \n
        <\/span><\/div>\n<\/div>\n<\/div>\n<\/div>\n
        \n
        \n
        \n

        <\/h4>\n<\/div>\n<\/div>\n<\/div>\n
        \n
        \n
        \n
          \n
        • The primary outcome<\/span> is <\/span>live full-term singleton births<\/span>, as this allow clinicians to inform couples of their chances of safely having a healthy baby.<\/span><\/li>\n
        • When this is not available then <\/span>live birth<\/span> had to be used as a proxy, but the quality of the evidence was downgraded.<\/span><\/li>\n
        • Clinical pregnancy<\/span> rates are more commonly recorded than live birth rates and are therefore used as a proxy for live full-term singleton birth where live birth rates are not reported.<\/span><\/li>\n<\/ul>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n
          \n
          <\/div>\n
          \n
          \n
          <\/div>\n
          \n
          \n
          \n
          \n
          <\/span><\/div>\n<\/div>\n<\/div>\n<\/div>\n
          \n
          \n
          \n

          Multiple births <\/span><\/h4>\n<\/div>\n<\/div>\n<\/div>\n
          \n
          \n
          \n

          Is the main risk to a mother and the baby and is linked to<\/span><\/p>\n

            \n
          •        Increased rates of preterm birth<\/span><\/li>\n
          •        Low birth weight and neonatal mortality in the baby<\/span><\/li>\n
          •        Pre-eclampsia in the mother.<\/span><\/li>\n
          • Multiple pregnancies lead to multiple births.<\/span><\/li>\n<\/ul>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n
            \n
            <\/div>\n
            \n
            \n
            \n
            \n
            <\/span><\/div>\n<\/div>\n<\/div>\n<\/div>\n
            \n
            \n
            \n

            Adverse Outcomes:<\/span><\/h4>\n<\/div>\n<\/div>\n<\/div>\n
            \n
            \n
            \n

            O<\/span>varian <\/span>H<\/span>yper<\/span>S<\/span>timulation <\/span>S<\/span>yndrome <\/span>OHSS<\/span> is a potentially life threatening condition and one of the main reasons that ovulation induction treatment is stopped or cancelled.<\/span><\/p>\n

             <\/span><\/p>\n

            Other adverse events<\/span> are:<\/span><\/p>\n

              \n
            • Miscarriage<\/span><\/li>\n
            • Stillbirth<\/span><\/li>\n
            •  Ectopic pregnancies<\/span><\/li>\n<\/ul>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n
              \n
              <\/div>\n
              \n
              \n
              <\/div>\n
              \n
              \n
              \n
              \n
              <\/span><\/div>\n<\/div>\n<\/div>\n<\/div>\n
              \n
              \n
              \n

              There is significantly higher live birth rates with IUI with stimulation compared with IUI without stimulation<\/em>, but also there were associated higher multiple pregnancy rates.<\/span><\/p>\n

               <\/span><\/p>\n

              In Vitro Fertilisation IVF is an alternative to IUI with stimulation.<\/span><\/p>\n

               <\/span><\/p>\n

              Several cycles of IUI with stimulation were required to match live birth rates achieved by a single IVF cycle, but with disadvantage of higher multiple birth rates as there was less control over the number of embryos produced.<\/span><\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n

              \n
              <\/div>\n
              \n
              \n
              <\/div>\n
              \n
              \n
              \n
              \n
              <\/span><\/div>\n<\/div>\n<\/div>\n<\/div>\n
              \n
              \n
              \n

              In conclusion <\/strong><\/h4>\n<\/div>\n<\/div>\n<\/div>\n
              \n
              \n
              \n

              IUI with stimulation should not be recommended in any situation.<\/strong><\/p>\n

               <\/em><\/p>\n

              IUI without stimulation is no better than expectant management.<\/strong><\/p>\n

               <\/em><\/p>\n

              IUI with stimulation is better than expectant management in all groups of women,<\/strong>but it significantly increases the risk of multiple pregnancies.<\/strong><\/p>\n

               <\/em><\/p>\n

              IUI with or without stimulation should not be routinely offered.<\/em><\/p>\n

               <\/em><\/p>\n

              In certain groups where vaginal sex is inappropriate or not possible; IUI without stimulation with sperm from a male partner or donor would be the first-line approach.<\/em><\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n

              \n
              <\/div>\n
              \n
              \n
              \n
              \n
              <\/span><\/div>\n<\/div>\n<\/div>\n<\/div>\n
              \n
              \n
              \n

              <\/h4>\n<\/div>\n<\/div>\n<\/div>\n
              \n
              \n
              \n

              Expectant management<\/strong> for two groups of women with unexplained infertility \u201cmild endometriosis or mild male factor infertility\u201d does not involve active clinical or therapeutic interventions and consist of:<\/span><\/p>\n

               <\/strong><\/p>\n

                \n
              •        Support to an individual or couple<\/span><\/li>\n<\/ul>\n

                 <\/span><\/p>\n

                  \n
                •        Provide information and advice about the regularity and timing of intercourse<\/span><\/li>\n<\/ul>\n

                   <\/span><\/p>\n

                    \n
                  •        Advice any lifestyle changes which might improve their chances of conceiving<\/span><\/li>\n<\/ul>\n

                    <\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n

                    \n
                    <\/div>\n
                    \n
                    \n
                    <\/div>\n
                    \n
                    \n
                    \n
                    \n
                    <\/span><\/div>\n<\/div>\n<\/div>\n<\/div>\n
                    \n
                    \n
                    \n

                    Unprotected regular vaginal intercourse<\/span><\/h4>\n<\/div>\n<\/div>\n<\/div>\n
                    \n
                    \n
                    \n