Best IUI treaments Tamil Nadu – Cost, success rate – IUI Chennai, Madurai, Coimbatore

To increase IUI Success rate in Iswarya IUI Centers special culture media

When ovulation induction can be attempted with sperm injected into the uterus then it is a type of infertility treatment called IUI which stands for Intra Uterine Insemination.

 

What is IUI?

Through a catheter when sperm are “washed” and placed into the uterus then that procedure is called IUI which stands for Intra Uterine Insemination. By masturbation, the male partner produces a semen sample. Separated from the prostaglandins, white blood cells, seminal plasma and other debris is the sperm which are filtered out during natural intercourse. Into the woman’s vagina a speculum is inserted and a catheter with an attached syringe which contains the washed sperm is inserted into the uterus through the cervix. The catheter and the speculum are removed when the specimen (“prepared semen”) is injected.

What are the prerequisites for IUI ?

  • Atleast one tube which is open / patent
  • Ovulation by ultrasound scan
  • Good sperm count / motility
  • Good endometrial lining

When and where are the sperm collected?

Either at home or in the hospital Sperm can be collected (within an hour specimen should arrive at hospital/laboratory). A special room for husbands and partners are available with us.

Does sperm need to be prepared before IUI?

Yes, approximately an hour is taken for preparation. Shortly after the sperm has been prepared insemination should occur.

Why semen sample is prepared ?

  • To capacitate the sperm and make it hyper motile
  • To remove the seminal plasma from sperms which contains prostagladins
  • Selection of motile sperms
  • To remove lymphocytes, cytokines, infectious substances from the semen sample
  • To reduce reactive oxygen species numbers
  • To remove non motile sperms
  • To process highly viscous sample

Process

  • Semen collection
  • Semen analysis
  • Semen preparation / wash
  • Semen analysis after
  • preparation
  • Sample loading
  • Performance of procedure IUI

IUI FAQS

  

It can cause some discomfort, mainly when the catheter is passed through the cervix. Some patients will describe it like a pap smear in terms of the level of discomfort.

Will I be successful with the IUI for the first time? A few cycles of IUI may be necessary before you are successful. Many fertility doctors recommend doing 2 inseminations back to back, to increase your chance of pregnancy.

How soon after IUI can I take a pregnancy test? Two weeks after the procedure.

IUI with fertility medications are about 20‐30% successful while approximately, natural IUI without medications has the success rate of 6‐10%.

Are there any risks associated with IUI? on a woman’s body IUI is the least stressful fertility treatment especially if fertility medications are not taken by the patient. Few risks are associated with it. During or after the procedure, however, cramping or spotting may occur.

IUI stands for Intra Uterine Insemination. Performance: Through the cervix a very thin flexible catheter is threaded and then a washed sperm is directly injected into the uterus. The whole process doesn’t take very long. A process that maybe takes a couple of minutes (60-90 seconds for the catheter and then the sperm injection to be introduced and to remove the catheter another 60-90 seconds), usually required by it is the insertion of a speculum and later the catheter and it is done slowly to reduce the discomfort. A tenaculum is used to hold the cervix sometimes, when the cervix is hard to reach. This makes the process a bit more uncomfortable. Shown below is a typical “Tomcat” catheter.

Through ejaculation into a sterile collection cup the sample is usually collected but for this purpose it is also possible to obtain collection condoms. Within a half hour of ejaculation, most clinics want the semen to be delivered around the time of liquefaction. So if one lives nearby, then the sample can be collected at home. If that is not so, one has to settle for a bathroom, a room at a clinic or any private setting. For washing, when the semen sample is dropped off and when it is inseminated there is a delay. Depending on the washing technique used is the amount of time which takes on the clinic’s scheduling 30 minutes to 2 hours. As soon as washing is completed most will perform the IUI.

Within 6 hours either side of ovulation ideally an IUI should be performed- some doctors believe for male factor infertility after ovulation is better otherwise before ovulation chances of success are higher with insemination with the sperm waiting for the egg. The IUIs are usually done between 24 and 48 hours later when timing is based on an hCG injection. To have a single IUI at about 36 hours post-hCG, would be a typical timing, though it is done by some at 24 hours, while better results are reported by some clinics when they do the IUI at 40-42 hours post-hcg. If there is a schedule of two IUIs spacing of 12 hours apart is done between 24 and 48 hours after the hCG. Some reports suggest it may increase success as much as 6 percent while some show no increase in success rates with two IUIs. On a natural LH surge some doctors will base the timing. A single IUI at 36 hours is the norm in that case but since ovulation may be a bit earlier doing them at 24 hours is also pretty common. Usually timed between 12 and 48 hours after the surge is detected two inseminations are planned. After it is released the egg is only viable for a maximum of 24 hours.

Searching a number of websites and about a dozen medical journal articles resulted in a range of statistics that was wide. The odds of success are basically, reported to be as high as 26 percent and just under 6 percent per cycle. as high 26 percent success was a result of multiple follicles while with one follicle the statistics were low. Another influencing factor is the sperm count. Odds of success are increased by higher sperm count. Judging from the articles which will be abstracted below, the overall success rate seems to be between 15-20 percent per cycle. 23-30 percent will be the rate of multiple gestation pregnancies.

Along the same lines as having a pap smear, IUI is considered to be fairly painless by most women. Some cramping can be felt afterward but usually, what is felt is related to ovulation rather than from the IUI. Since the cervix is already slightly open for ovulation the catheter usually doesn’t feel like much. Discomfort at the cervix may be caused by a poorly timed IUI. For more details see the personal experiences given below.

Along the same lines as having a pap smear, IUI is considered to be fairly painless by most women. Some cramping can be felt afterward but usually, what is felt is related to ovulation rather than from the IUI. Since the cervix is already slightly open for ovulation the catheter usually doesn’t feel like much. Discomfort at the cervix may be caused by a poorly timed IUI. For more details see the personal experiences given below.

As the cervix doesn’t remain open you don’t have to lay down but most doctors after the procedure make the patients lie down on the table for 15-30 minutes.

If you don’t feel well afterward or if you have cramping it makes sense to take it easy for a while but most people don’t need to. With hopes it will increase the chance of implantation aerobic activity and heavy lifting will be reduced by some people during the luteal phase. As that is a more invasive process it is more important to take it easy for a bit after IVF.

The individual situation plays a role in this but mostly it should not be for more than 72 hours since his last ejaculation for the best motility and morphology to be ensured. Between ejaculation and collecting sperm for the IUI, it is generally best to wait 48 hours where low sperm count is the reason for IUI. It makes sense to wait at least 24 hours with no sperm count issues. Suggested by some is to try for about 36 hours to cover the maximum territory with counts that are high- to have intercourse around the time of hCG injection is a common suggestion.

Any time after an IUI intercourse can be had. In fact, when that is an option, most doctors suggest having intercourse, soon after the last IUI to ensure ovulation is covered. Suggested by your doctor would be to wait 48 hours to resume relations if a tenaculum is used or if you had any bleeding during the IUI.

The sperm does not fall out once it is injected into the uterus. However, there can be, after the procedure, increased wetness because of the catheter loosening mucus in the cervix and to enable it to flow out. To prevent leakage, some doctors will insert a cup around the cervix, but most do not.

The cervical mucus is loosened by the catheter and allows it to come out more easily. For this reason, It is common to see more fertile mucus after an IUI apart from the fact that IUI that is well timed should be close to evaluation.

Either 3-4 follicles gives one the best chance of getting pregnant, according to different studies, while if there are more follicles beyond that the risk of multiples simply increases. With data stating 3 in other countries the U.S. study said 4 follicles. 3 may be more likely to be the correct answer, as the U.S. has a higher rate of multiple births.

Where cervical mucus is a problem, IUI can help with Clomid cycles and no matter what the sperm count is, IUI increases the chance of success on injectable cycles. If you can and haven’t had success with intercourse it does make sense to try IUI. It is important to note that through the cervical mucus and up into the uterus and fallopian tubes, only the best and strongest sperm make it with intercourse. More sperm will be available for fertilization with IUI.

With a significant reduction in pregnancy rates, a count above one million washed appears necessary for success when the inseminated count is lower than 5-10 million (in other words, 10 million should be considered for cost-effective and 5 million a lower limit for success. Increasing counts over 50 million do not appear to offer an advantage while with washed counts over 20-30 million there are higher success rates. For one month of various treatments, advanced fertility has a chart of success rates.

It depends on what meds you are doing and what you can afford. Before moving on to injectables, one might do 3-4 IUIs on Clomid then do 3-4 cycles on injectables. Even after four good ovulatory cycles, it would be time to consider IVF, if one doesn’t have success on injectables with well-timed IUI.

Without medical supervision, an IUI shouldn’t be done at home because to prevent infection, the sperm needs to be washed- i.e., separated from the semen. At home, a vaginal insemination can be done but is no more successful than intercourse. To instruct on doing ICI (intracervical insemination) at home, some doctors are willing, but without being taught proper technique it should not be attempted. It could be quite dangerous if you get semen or air into the uterus- may be even life-threatening. It may be worth asking about as one woman wrote in to say there is a midwife practice in Berkeley, CA and that at the patient’s home insemination will be done.

It isn’t uncommon but it doesn’t usually happen. If the doctor has trouble reaching the cervix it is most common to have some bleeding. Also, some women have light bleeding with ovulation.

The cost is dependent on the type of IUI Cycle. Stimulation cycle costs higher and Natural cycle costs less. With much higher results, stimulation with gonadotropin injection is much costlier. The IUI procedure approximately costs Rs.3500.

Mostly, this depends mostly on how the female is being treated. Often timed to over the counter ovulation prediction kits, a natural cycle costs $15-60 for 5-9 tests. The monitoring can be increased by the use of clomiphene citrate but most of the doctors settle for one u/s around cycle day 12 or don’t do ultrasounds. The necessity of ultrasounds, blood work and medical costs are increased by Gonadotropins.

During IUI cycles many doctors monitor follicle development. When the dominant follicle is within a certain size range, most trigger. The norms are FSH-only meds 17 or 18mm minimum, unmedicated 20-24mm, and FSH+LH would be 16 or 17mm minimum, clomiphene citrate 20-24mm, while there is always some difference in doctor preference. There are possibilities for follicles that are slightly smaller, 14-15mm, to contain a viable egg. Also, usually at a rate of about 1-2 mm per day follicles continue to grow until they release. The releases will occur within 24 hours though a woman may ovulate more than one follicle in a cycle. Only follicles close in size are likely to release when hCG is not used. The use of hCG will get most mature follicles to rupture and induces ovulation in about 95 percent of women.

per 18mm follicle the E2 level should be 200-600pg/ml. With a minimum level of 150, some doctors are content but higher tends to be better.

Some of the main risks are, introduction of infection (inclusive of sexually transmitted disease from the sperm itself- to be sure of the known donor’s health, it helps or use frozen specimens that are carefully monitored), minor injury to the cervix that leads to bleeding or spotting and some discomfort such as cramping. Associated with the use of ovulation induction medications like gonadotropin therapy (higher risk) and clomiphene citrate (low risk), there are also risks of hyper stimulation. Adequate monitoring and proper technique reduce risks.

For pain associated with IUI, most women don’t need medication. It is best to avoid medications like ibuprofen and naproxen (NSAIDS), if there is cramping but considered safe would be Tylenol (but maybe not that helpful for cramps).

Also called sometimes as sperm preparation or spinning, it is a technique in the laboratory for separating sperm from semen and to separate motile sperm from non-motile sperm for use in assisted reproduction (IVF, IUI). For near normal specimens, the washing technique is after liquefaction, mixing the ejaculate with the appropriate washing medium followed by centrifugation (separating materials with different densities by spinning them at high speed is a machine called centrifuge). In more washing medium the sediment (sperm-rich fraction) is re-suspended and the supernatant is discarded. Maximum, this process is repeated 2-3 times. Re-suspended in 0.5 cc of the medium is the sediment in the final wash which is then deposited in the uterus after being loaded into a syringe. Carefully layered on top of 0.2-0.5 cc of semen are two to five cc of the medium and this is technique is called “Sperm Rise” or “Swim Up”. Into the culture medium, motile sperm cells “swim-up”. The medium which contains motile sperm cells) is carefully harvested and centrifuged after some time (30-90 minutes). To harvest more sperm cells, on top of the seminal fluid, fresh medium is layered again, if necessary. A dense liquid phase is utilized to separate sperm cells from seminal fluid and debris and this is called the discontinuous gradient centrifugation technique. Commercially available, are different compounds that may be used. Subjected to centrifugation is the semen which is deposited on top of this fluid. Used for IUI after further washing, motile sperm cells migrate to the bottom of the tube.

It is OK to swim shortly after your IUI since the vagina doesn’t open unless something pushes it but it probably makes sense to wait 48 hours after your IUIs to go swimming because of how much one has invested in getting pregnant.

No. because it prevents the sperm and egg from meeting a tubal ligation is an effective birth control. Having an egg released from a follicle in the ovary and then beginning the journey through the fallopian tube to the uterus is the process that leads to pregnancy. Through the cervix from the vagina sperm will travel through the uterus into the tube where the fertilization occurs. The need for the sperm to travel through the cervix is bypassed by IUI, but that is it. Fertilization won’t take place as it doesn’t get the egg to the other side of the obstruction. The only way to get pregnant after tubal ligation is by having an assisted reproduction technology that is inclusive of egg retrieval such as in vitro fertilization (IVF) or by having reversal surgery.

 

 

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