It is essential that your fallopian tubes are confirmed to be open and healthy before the IUI process begins. A tubal patency test is usually carried out as part of your assessment by the fertility clinic.
The typical method for assessing the health of your pelvis and the patency of your fallopian tubes is Contrast Study and Laparoscopy.
Contrast Study, popularly known as Hystero-Salpingo Graphy(HSG) is an x-ray study wherein contrast is injected through the vagina and cervix into the uterus. The constrast material (loosely known as Dye) is seen under the x-ray image intensifier, traveling through the fallopian tubes into the abdominal cavity. This spillage of contrast in to the abdoman confirms patiency of the tube of that particular side. In patient's language, this study is known as "Tube Test"
At laparoscopy, a direct view of the pelvis is obtained by inserting a telescope into the abdomen. When the pelvis and tubes are healthy, dye passes freely through both the tubes. There should be no adhesions present that might prevent an egg from having access to either tube from the ovaries. This is performed under a short general anaesthetic.
The test may show that you only have one open healthy tube although you may have both ovaries. IUI treatment can then only be carried out when there is evidence that ovulation is about to occur from the ovary that is on the same side as the open tube.
The second essential requirement is that semen is of optimum quality.
In case IUI is recommended to you, you may want to discuss the following options with your clinician:
IUI with or without fertility drugs:- as IUI can be done with or without fertility drugs to boost egg production. You should discuss the risks involved in using fertility drugs and whether IUI without fertility drugs might be suitable for you.
IUI with partner’s semen or donor semen:- Instead of using your partner’s semen, if your partner is unable to provide semen, or if you do not have a male partner, you may want to consider using donated semen.
If IUI is unsuccessful:- you may want to talk to your clinician about other procedures such as In Vitro Fertilisation (IVF).
How does IUI work?
Step1: If you are not using fertility drugs, IUI is done between day 12 and day 16 of your monthly cycle – with day one being the first day of your period. Blood or urine tests are done to identify when you are about to ovulate. If you use fertility drugs to stimulate ovulation, vaginal ultrasound scan is used to track the development of your eggs. As soon as mature eggs are seen, you are given a hormone injection to stimulate their release.
Step2: The sperms are inserted 36 to 40 hours later. To do this, the doctor first inserts a speculum (a special instrument that keeps your vaginal walls apart) into the vagina (as for a cervical smear test). A small catheter (a soft, flexible tube) is then threaded into your womb via your cervix. The best quality sperm are selected and inserted through the catheter. The whole process takes just a few minutes and is usually painless but some women may experience a temporary, mens-like cramping.
Step3: You may wish to rest for a short time before going home. We recommend a 2-hours rest before sending you home.
Step 1: You will be asked to produce a semen sample on the day the treatment takes place.
Step 2: Sperms are washed to remove the fluid surrounding them and the rapidly moving sperms separated out.
Step 3: The rapidly moving sperms are placed in a small catheter (tube) to be inserted into the womb.
IUI SUCCESS RATES
IUI success rates are just OK, and the reported success rates from various centres world over range from 8-20% only.
For IUI cycles without fertility drugs, probability of success remains very low.
Age and IUI Success
Age plays a big part in IUI success.
In a study of IUI success for women over age 40, the findings showed a very low pregnancy rate, at just 2% (and the pregnancies only happened in the first IUI cycle tried). Researchers recommended that if IUI is used in a woman over 40, that only one cycle should be attempted.
If that cycle fails, then moving onto IVF would be recommended. Though with such a low success rate, it's probably best to move straight to IVF in most cases.
For women under age 40, the recommendation is three cycles of IUI, before moving onto IVF treatment.
One study found that IUI success rates were 16.4% per cycle for the first three tries, or 39.2% if looking at all three trials together.
However, for IUI treatments cycles 4 through 6, the success rate dropped significantly to only 5.6%. This steep drop after three unsuccessful tries at IUI is why moving onto IVF is recommended at this stage.
When Are Your Odds for IUI Success Better?
IUI has better success rates for mild to moderate male infertility than severe male infertility. For severe male infertility, IVF treatment may be a better choice. If a sperm donor is being used, then IUI would be good choice, especially if there are mild or no female infertility factors.
IUI treatment is also a good choice if hostile cervical mucus is the cause of infertility. (Of course, other factors should also be taken into account like male infertility and woman's age.)