Advantages and Disadvantages of IUI

Intrauterine Insemination or IUI is one of the first types of fertility intervention procedures, often recommended for couples with unexplained infertility. It is one kind of artificial insemination () treatment. IUI treatment involves placing sperm inside a woman’s uterus in order to facilitate fertilization. The major goal of IUI treatment is to increase the chance of fertilization by increasing the number of sperms that reach the fallopian tubes.

Compared to in-vitro fertilization, Intrauterine Insemination (IUI) is a less expensive and less invasive treatment. IUI is a simpler fertility treatment which may be done with or without fertility drugs. The IUI procedure involves transferring washed semen directly into the uterus via a thin catheter.

A Few years back, artificial insemination () was only performed in cases of psychologic dysfunction and on male subfertility. Due to the routine use of post-coital tests, other indications were added that includes immunologic causes and hostile cervical mucus. IUI can be performed using either donor’s sperm or husband’s sperm. Also, the woman should be evaluated to check for any hormonal imbalance, structural problem or any infection. Ovulation can be predicted using a blood test or through urine test kit and ultrasound.

What are the indications for IUI?

IUI can be recommended in the below situations –

• Unexplained infertility
• Mild Male factor | Infertility | Sub fertility, Decreased Sperm Count / Oligospermia | Ejaculatory Dysfunction
• Cervical Factor Infertility | Hostile cervical mucus – Cervical scar from past procedures which hinders sperm passage to Uterus.
• If fertility drug treatment alone is not successful
• When a sperm donor is used
• When intercourse is not possible due to pain during coitus(Dyspareunia)
• Semen allergy

Apart from this, IUI is not recommended for people with below situations –

• Previous pelvic infection
• Severe endometriosis
• Blocked fallopian tubes

IUI Procedure and steps

The procedure of IUI is simpler and can be broken down into 3 simple steps –

1. Tracking of ovulation and to identify a fertile period.
2. Collection and washing of semen.
3. Insertion of sperm directly into the uterus.

Washing of sperm is important as it eliminates everything except the healthiest and most mobile sperm. This sperm has the best chance to reach the egg. It causes pain and cramps if the semen is inserted directly into the uterus.

IUI treatment costs much less compared to IVF. The price may vary from clinic to clinic. It is advisable for the couple to consult a doctor and understand the overall process of IUI.

Benefits of IUI

IUI can be done without any medication through fertility drugs to induce ovulation and increase the number of eggs available. Some of the benefits of IUI are –

1. Possible to perform Natural Cycle IUI

It is possible to perform a natural cycle i.e. with low stimulation medication or with a clomifene citrate to stimulate follicles. The unacceptable high multiple gestation rates after ovarian hyperstimulation are prevented due to minimal dose and natural cycle IUI.

2. Sperm quality is enhanced due to the washing procedure

The prostaglandins, infectious agents, antigenic proteins, non-motile spermatozoa, leucocytes, and immature germ cells are removed by the washing procedure which ultimately increases sperm quality.

3. IUI is a less invasive method and moreover a physiological treatment

In IUI, sperms are washed, concentrated, and placed in a woman’s uterus via a catheter. There is no oocyte retrieval like IVF.

4. IUI is a less expensive treatment

Compared to IVF, IUI is a less expensive fertility treatment option. IUI costs around

Rs. 3000 while the average cost of IVF treatment cycle costs around Rs. 5000 to Rs. 10000.

5. The treatment timing is short

IUI process lasts for about 60 to 90 seconds after which doctors advise the patient to seat for a couple of minutes.

6. IUI is more effective than ICI (Intracervical Insemination) treatment

In ICI, sperms are placed into the cervix, after which the sperm make their way to the uterus. They fertilize the oocyte and follows the procedure of natural fertilization. Whereas in IUI, the sperms are placed directly inside the uterus and you do not have to rely on the sperm traveling through the uterus. This increases the chances of fertilization.

Benefits of IUI treatment

Even though the success rate of IUI is lower than IVF, here are some of the benefits of proceeding with the IUI treatment.

1. Less stress on the body

IUI offers gentler conditions than other treatments like IVF which can be harsh and aggressive and can affect the egg quality.

2. IUI treatment increases the chances when compared to regular sex.

IUI helps the sperms to be fast-tracked straight to the egg for fertilization as compared to regular sex where only the strongest sperm can make it to the cervical mucus and then to the uterus and fallopian tubes.

3. There are fewer chances of Ovarian Hyperstimulation Syndrome (OHSS).
4. A natural cycle is followed with IUI which is less invasive on the body and uterus as compared to treatments like IVF.
5. IUI is a great way to understand how the body will react before directly going for treatments like IVF. Also, it can help not to waste a cycle.
6. Cost less than other treatment like IVF

The cost of IUI is less than IVF which can be affordable by most of the couples easily.

Some of the factors influencing IUI success includes primary or secondary subfertility, the duration of subfertility, endometriosis, and usage or non-usage of ovarian hyperstimulation.

IUI disadvantages

Even though IUI is a great option for most of the couples, it does not address all the fertility challenges at times. Some of the disadvantages of IUI treatments are mentioned as follows –

1. A high degree of intervention can occur, if the following factors are not met:

• Clear and undamaged fallopian tubes
• Partner should be ovulating while carrying out the pregnancy test
• Sperm should have a certain level of motility

2. The chances of getting pregnant are low in IUI as compared to other treatments like IVF. The success rate is as high as 20 percent.
3. The risk of multiples i.e. having twins, triplets or more is much higher as there is little control over how many eggs will develop and difficult to guarantee how many will fertilize.

IUI Risk Factors

IUI has low-risk factors compared to other treatments. Some of the risk factors of IUI are –

• The fertility drugs used during the treatment can be a factor for risk sometimes. There can be a chance of developing Ovarian Hyperstimulation Syndrome (OHSS) while using gonadotropins. There is a risk of conceiving multiples i.e. twins, triplets, or even more while taking gonadotropins. Hence it is important to monitor during the procedure.
• The fertility drugs can cause side effects such as mood swings, depression, hot flashes, headaches, nausea, visual disturbances, pelvic discomfort, swollen and painful ovaries, breast tenderness, bloating, ovarian cycles, and swelling and rashes around the injection sites. These side effects are usually mild and often disappear after medication.
• There is a chance of the cycle getting canceled due to too many potential follicles. The doctor can ask to abstain the couple from sexual intercourse and ask to try again another time. There can be a risk for the couple as well as for the baby if the instructions are not properly followed.
• There can be slight chances of developing an infection as a result of the IUI procedure. There can be a small amount of vaginal bleeding during the process of placing the catheter in the uterus.

Women often experience little or less pain during IUI treatment. Mild cramping and injection can be experienced, which are rare cases. The success rate of IUI depends on the age and also the cause of infertility. As per the study, the success rate is 47.4 percent for anovulation, 41.7 percent for male infertility issue, 35.1 percent for unexplained infertility, 13.4 percent for poor sperm motility, and 10.7 percent for endometriosis.

The procedure takes less time and is less painful. Once the procedure is done, the patient can experience some light spotting for a day or two. Doctors will instruct to take the blood test after about two weeks. Patients are advised not to be impatient as the result can turn out to be a false positive or false negative. In case if the patient does not conceive, the IUI procedure can be tried again. Same therapy is used to maximize the chances of pregnancy for three to six months of duration.

IUI treatment is a better choice if IVF is too expensive for your budget. In case, if you are nervous about the IUI treatment, you can discuss the concerns with the doctor. It is essential to go through the basic information about the treatments, benefits, complications, risk and choose the correct decision. It is always advisable to understand all the options and risk before proceeding with the IUI treatment.