Last Updated on March 19, 2024 by Partha Protim Choudhury
IUI plays a role in modern fertility treatment by offering a middle ground between natural conception and a more intensive assistive reproductive technology catering to the diverse needs and preferences of couples and individuals facing fertility challenges. Dr Shital Punjabi is an IVF Specialist holding 25+ years of experience in gynaecology. She’s also the Founding Director of Shashwat IVF and Women Hospital and the IVF Department at Motherhood Women’s Hospital. She also has experience as a consultant in cosmetic gynaecology. THIP Media scheduled an exclusive interview with her on IUI. Readers can access the full interview here in this YouTube link.
Q. How is IUI performed and what is the timing of the procedure?
IUI is basically a kind of assisted reproductive technology which we offer to young couples married for just two to three years and having both the fellow pin tubes open and with a near normal, moderately normal seminar examination report. And usually, we do IUI on the day of the ovulation once we confirm with the transmogrify and blood report that she has ovulated and now she is in her fertile period. Usually, it is between the 12th day to 16th day of the period of a female that we are doing IUI.
Q. What is the success rate of this procedure and are there any factors which can be related to its failure?
Yeah, success is like around 10% to 15% per attempt of IUI. Now the criteria are if the egg quality is good, if she doesn’t have any major hormonal dysfunction prior to that. If the female has a good functioning fallopian tube, her uterine blood circulation and uterus. These are the three major factors which affect the pregnancy rate per IUI attempt.
Q. Are there any chances of multiple pregnancies with IUI? And how is this risk mitigated?
See, in IUI, what we usually do is we give some ovulation induction agents. We call it controlled ovarian hyperstimulation. So, in some couples, the doctor administers tablets to the female for super ovulation. In a few females, we give injections. In the IUI cycle, usually we get two to four eggs from the female. So, there are increased chances of twins in IUI to like around 100 IUI success couples. Four to eight cut wins of that. So, this incidence is around four couples in 100 couples of successful IUI.
Now if you want to reduce the chances of twin pregnancy, then we can select the protocol for ovulation. If she doesn’t produce many eggs, we can mitigate the risk of multiple pregnancy in that.
Q. What are the medications involved in the IUI process?
Letrozole is one tablet which is available and used for ovulation induction across the world. Depending on the age and weight and height, like the BMI of the female, the dose is decided most of the time. It starts from the third day of the menstrual cycle to approximately five days or sometimes extended up to ten days also. So that is the one molecule which has been giving consistent results in almost all females.
The second preferred molecule is clomiphene citrate. That also we are giving and that also has proven good results in supervision. Inserted patients who have suffered from PCOD endometriosis or their age is more, or their fertility index is relatively low. So then in those patients we add gonadotropins. Also, in gonadotropins there are two major variants.
One is purified FSH, and the other is FSH plus LH. We call it human menopausal gonadotropins – HNG. But IUIB, usually the data across the world, has suggested that FSH plus a little amount of LH which is physiological, gives better results.
Q. Are there any lifestyle changes or precautions which are needed while or before undergoing an IUI procedure?
Yeah, I would definitely suggest it because to optimise the results in IUI, if a couple likes they take a good amount of folic acid B12, at least minimum three months prior to the plan for their pregnancy. It increases our chances of success per IUI attempt. That is one thing. Second, if the ovary is good and normal, there is nothing to worry about. But if ovaries are relatively older or aged and relatively exhausted of the number of the eggs, then the antioxidants and the micronutrients for the ovary and sometimes BHA, that is a substrate which is required for most so many patients of 35 years plus age. So, for them, giving three months of the pretreatment before going for IUI increases our chances of success. That is for intended females.
Now for male also it is similar. If the male is smoking or like consuming alcohol or something, then they can reduce that and they can take antioxidants which helps in better cement parameters and better sperm qualities and better fertility index of the sperm. So, this is important. For lifestyle changes, both of them should be calm, cool. So, they must be doing some good meditation or something for a very long period of time. Then it increases their chances of pregnancy.
If a female or male, either of them is higher weight, then they can work on their weight first and then that weight like reduce the weight particularly in those heavy females and having PCOD. So, in them we always advise that you reduce your weight by at least minimum 10%. And that will increase our chances of IUI minimally by 100%.
Q. Are there any potential risks or complications associated with the IUI procedure?
Very good question. Actually, you know, everybody must know this, that all medical procedures, the way they are beneficial, have their own risks. Also, if they are being used judiciously in the right hand with the right treatment protocols and with the nice best practices, best IO practices in the andrology lab. If one follows that, then no worries. Otherwise, we’ll start one by one. If we have given very high dosage of gonadotropins or we have given very high dosage of ovulation induction agents, then it may result in multiple egg selections which may result in ovarian hyperstimulation syndrome, it may result in multiple pregnancy.
Second, if the patient is not given antibiotics and all and particularly in the male factor and if there is infection present in the semen then during IUI procedure, as we are putting the cannula inside the uterus. Now we have a pipeline with cervix and put the cement separate QA sperms inside the uterus. And if the antibiotic is not given or the endurology lab has not taken astringent protocols for completely aseptic preparation of the sperms. So, then we may introduce infection directly inside the uterus, right?
Third, while insertion of the IUI cannula if the aseptic measures are not taken, then again like we are introducing the infection inside the uterus. And I tell you, I’ve been practising for 27 years, and I have seen so many patients. And then there is septic collection of the pulse inside the peritoneal cavity and then accept surgical drainage of that. This is to be done by laparoscopy. There are no other chances that she would recover from that infection.
Q. What is the typical cost of the IUI procedure and what does the cost include (from the collection to the sterilisation)?
…So that media is being used from cement to take out the sperm. Then from sperms to take out the best quality sperms. And then from those sperms to actually activate those sperms. That is like a complete process. That process is done in the andrology lab. So that is another expenditure. The tentative cost lies between 8000 to 15,000, depending on the city where one prefers to do.
This is what I’m talking about in India. And the injection or ovulation agents. They may range from Rs 500 to Rs 5000. This depends on the pathology. The third thing is serial sonography. When we give any ovulation induction agent, we have to do a sonography of that female from the 9th day of her period till she ovulates. So, two to three times the female has to go to either a radiologist who does the sonography or a gynaecologist. And she goes through her ultrasonography for checking both the ovaries and uterus, and the number of the eggs, the size of the eggs, the ocular study of the egg for the blood circulation.
So, this is the third expenditure. And that varies between Rs 1500 to Rs 3000. Depending on the city she is getting the treatment. On an average, we can say these three things are a major expense. And that comes to Rs 10,000 minimum, to Rs 25,000 maximum, depends on the pathology.
Q. Is there an upper limit of the cycles of IUI? Cycles which are recommended before considering any other option?
So, for all those females who are 30 plus, with the data of our own Indian population, max to max, we advise them to go for IUI for three attempts, even if they are absolutely normal. We call them unexplained fertility in most of the patients. And we advise them to go for three IUI. If by three IUI attempts, if they do not get the successful result, that is pregnancy, then we tell them that your biological clock is all the time ticking and go faster in the direction of having your own biological child. So, in that case, after three IUI, if you do not get the success, we advise them to go ahead with IVF. So, this is the one thing…
For the third group of the patients, parameters are borderline, or the husband has a progressive pathology like, who is near to smokes or radars, or like certain things, sperms kill each other. These factors are very detrimental to sperm fertility. We advise them that if you do not get the results by cycle, if your pathology is like over a period of time it is getting more and more troublesome.
Then, we wait for the three cycles. If you do not get the results, then proceed further for IVF and otherwise in IVF also the very last number of the sperms active and fertile sperms even in IVF also results are nearly half than in other cases of right. So, it is important that max wait for the three cycles of IUI and then straight away proceed for IVF.
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