IUI process

1. IUI Intrauterine insemination (IUI) also called, artificial insemination, is one of the most cost- efficient and effective infertility treatments of modern times. It is an artificial reproductive technique where the women's uterus is artificially introduced to the male sperms with the help of a flexible tube.

2. What tests do men have to take before the IUI Treatment? About 40% of total infertility cases are due to male factor infertility. Your doctor will advise you to undergo complete physical examination and batteries of tests to identify the underlying cause of infertility. The test results will help your fertility expert in determining the best available treatment options. Your doctor will advise you tests like, Semen analysis An experienced andrologist analyzes the semen under a microscope to know the viability and count of sperms. The semen analysis helps your doctor in understanding the sperm morphology and sperm count, and eventually, help in determining the most effective fertility options. Based on your semen report, your doctor will advise you one of these treatment options, timed intercourse, intrauterine insemination (IUI), conventional IVF, intracytoplasmic sperm injection (ICSI), which can be done during ovulation. Some of the available options are timed intercourse, intrauterine insemination, conventional IVF, intracytoplasmic sperm injection (ICSI), which can be done during ovulation. Anti-sperm antibodies This test detects the presence of abnormal particles called antibodies, in blood and Antisperm antibody test detects special proteins (antibodies) that destroy man's sperm in blood, vaginal fluids or semen. These antibodies, if present, will damage or kill sperm making the fertilization of egg difficult. Infertility caused due to these antibodies is called immunologic infertility. Karyotyping Karyotyping is a chromosomal analysis that helps in detecting potentially significant abnormalities that can cause problems in fertilization and pregnancy. If your doctor suspects chromosomal abnormalities, he might advise IVF treatment along with Preimplantation Genetic Diagnosis (PGD screening).

3. Y chromosome deletion testing (genetic disorder testing) Male infertility could be because of a genetic disorder called Y chromosome microdeletion (YCM). The man suffering from Y-chromosome infertility may produce either very few sperm cells (oligospermia), no sperm at all (azoospermia), or sperm cells with abnormal morphology. Y chromosome deletion testing (genetic disorder testing) is the blood test that can reveal the mutation in the Y chromosome. Men with oligospermia may also be helped with assisted reproductive technologies; most men with Y chromosome infertility have some sperm cells in the testes that can be extracted for this purpose. Sperm Chromatin Structure Assay (SCSA) The sperm chromatin structure assay test is a new diagnostic tool that can detect DNA fragmentation in the sperm. The high degree of DNA fragmentation in sperm prevents full-term pregnancy leading to miscarriage. This test is advised for couples who have experienced multiple miscarriages. Although the good news is that innovative reproductive techniques such as IVF along with ICSI can help in getting pregnant. Testicular Biopsy Your fertility expert may suggest a testicular biopsy if the semen analysis suggests abnormal sperm and the cause is not identified. During a testicular biopsy, a sample from the testicles is collected with the needle and analyzed in the laboratory. In some cases, sperm collected during the biopsy can also be used for fertility treatments like IVF and IUI. Your doctor will prescribe you a battery of tests to finalize the most efficient treatment plan and achieve the ultimate goal of pregnancy.

4. How is ovulation induced during the IUI Treatment? Most of the IUI treatment cycles are done after inducing ovulation in the woman. To have more follicles, and release more than one egg and develop better quality egg, the woman is given ovulation stimulant drugs before starting the IUI. Doctors may not prescribe ovulation stimulating drugs in women with healthy eggs. Though in other circumstances, where the quality of eggs is low, ovulation stimulating medication is required. Before taking any injectable drugs, a woman has to undergo a baseline ultrasound and a blood test. Some of the most commonly used ovulation induction medicine are as follows: Oral Tablets Oral medications like Clomid and Letrozole are used to induce ovulation in women who are unable to ovulate on their own or have irregular ovulation. The ovulation induction medicine stimulates the release of hormones that drives egg production and release. Your doctor will prescribe Clomid or letrozole to be taken between days three and seven or between days five and nine of your menstruation cycle. Injectables or Gonadotropins If you are unable to ovulate even after the oral medication, your doctor may prescribe injectable medications like follicle- stimulating hormone (FSH) and luteinizing hormone (LH). These preparations are taken by subcutaneous injections or intramuscular injections to stimulate ovulation. These medicines provide more powerful stimulation as compared to oral tablets and would require constant monitoring. After the ultrasound and blood work on the third day of your menstruation cycle, your doctor will put you on hormone injections. The injectable medications are started on day three and are continued for six to 10 days, depending on response. During this, your doctor might ask you to undergo two or three ultrasound and blood work to monitor the progress.

5. How is ovulation monitored in IUI Treatment? Ovulation monitoring is important in every fertility treatment. In IUI or artificial insemination, the frequency of monitoring differs according to the types of the cycle. IUI with the natural cycle Natural cycles with IUI treatment requires the least amount of monitoring. Over the counter ovulation predictor kits (LH predictor kits) are used to find the correct time of ovulation, and IUI is planned accordingly. Your doctor might also advise an ultrasound between day 11 to day 14 of your menstrual cycle to determine the growth and maturation of ovarian follicles. Afterwards, HCG is administered which will stimulate ovulation within 36 to 44 hours. Once the ovulation begins, the insemination of male sperm is done. Clomid Cycle or IUI with Oral Tablets IUI treatment with clomiphene citrate cycles is monitored more closely. Your doctor will advise ultrasound on days 2, 3 or 4 of your cycle to rule out ovarian cyst before starting the Clomid. Taking Clomid despite having an ovarian cyst can lead to an abnormal reaction and enlargement of existing cysts. If the ultrasound shows no cysts, your doctor will prescribe from 50 to 150 milligrams of Clomid for 5 days. During the middle of the cycle (between 11–14 days), an ultrasound is done to measure the number of mature follicles (20–24 mm) and evaluate the endometrial lining. Once mature follicles are present then HCG is given to stimulate ovulation, and within 24-48 hours of that IUI is done. IUI Treatment with Gonadotropin Cycles (Fertility Shots) IUI treatment with a fertility shot is more expensive due to the need for extra medicine, blood work, and ultrasound. Under this type of IUI treatment, baseline ultrasound is done between 2nd to 4th day to ensure the absence of ovarian cyst. After this, injectable medication is given. For a few days, blood work is done and blood hormone levels are tested to monitor the growth of follicles and ensure that the ovaries are not overstimulated (Ovarian hyperstimulation syndrome).

6. How is sperm prepared for injecting in the IUI Treatment? To get good quality sperm, one must abstain from ejaculation for about 2 to 4 days before providing the semen sample. The semen can be collected at home or in a clinic and is stored in a sterile sample cup. In cases of home collection, the semen must reach the lab within an hour of ejaculation. Once at the lab, the semen is safely kept at a dark temperature- controlled place. The sperms are separated from the semen by the process of sperm washing. Sperm washing is a technique where chemicals that may cause an adverse reaction in the uterus are removed from the semen. Sperm processing takes about 30 to 90 minutes. The best quality sperms are used for insemination. In certain cases such as logistic concerns, oligospermia, or ejaculatory dysfunctions, the best quality sperms are separated, frozen and stored in the laboratory for later use. The cryopreserved sperm is melted 2–3 hours before the process of insemination in the clinic. What is the right time of insemination during the IUI Treatment? The insemination must be done at the right time. It should either be done during ovulation or right before ovulation. Usually, the sperm can stay alive in the female reproductive tract for up to 5 days (after having intercourse), because of which they can fertilize an egg. Although, the egg can be fertilized only within 12–24 hours post-release. IUI insemination must be at the right time so that the egg and the sperm are present in the fallopian tube at the same time. That’s why the process of IUI is mostly done one or two days after ovulation. Your fertility expert will align the insemination date with your ovulation dates.

7. Is IUI treatment Painful? The process of insemination is done in the fertility clinic under your fertility experts' guidance. Insemination is a quick process and usually requires only a few minutes. The total time for one cycle is roughly about 15 to 20 minutes. During the procedure During the procedure, you will be asked to lie down on the table and your feet would be put in the stirrups. Then a speculum would be inserted in your vagina — the experience will be quite similar to what you had during your pap smear. The gynaecologist will enter a flexible long tube (catheter) through your cervix into your uterus. The sperm is then pushed into the catheter with the help of a syringe. After the procedure After insemination, based on your doctor will ask you to remain lying down with elevated hips for about 10 minutes. You are free to resume your normal activities after this. Some women might feel discomfort during the procedure and can experience cramps or spotting on the day of the insemination. The successful pregnancy can be tested within 14 days of insemination.

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