A woman undergoes intrauterine insemination (IUI) when processed sperm is directly injected into her uterus. During natural conception, sperm travel from the vagina through the cervix, into the uterus and up into the fallopian tubes. IUI involves washing the sperm, concentrating them, and placing them directly in the uterus near the egg which lies waiting for the sperm in the Fallopian tubes. This process may increase the chances of pregnancy in couples who have had difficulty conceiving. Dr Gautam Allahbadia, Mumbai based IVF expert and specialist, explains IUI and educates men with asthenozoospermia giving them hope for becoming parents.
The expert informs, “Some women may experience mild to moderate cramps as the catheter is passed through the cervix and into their uteri. In some cases, you may injure the cervix when inserting the IUI catheter, causing acute pain, spotting, or bleeding.” He adds, “The chances of this happening are low if you use a soft or ultra-soft IUI catheter, partially full bladder, and trans abdominal ultrasound guidance. A little post-procedure spotting won’t affect the pregnancy rate. If, however, your catheter has damaged the endometrium and blood is discovered inside the lumen of the IUI catheter or outside the surface of the IUI catheter, the success rate drops drastically.”
Enlightening about male infertility which is most commonly associated with asthenozoospermia, a condition characterised by reduced motility or no motility in fresh ejaculates, Dr Allahbadia, Mumbai based IVF expert informs, “A reduced sperm motility prevents sperm from reaching an egg and fertilising it, causing the patient’s fertility to be affected. The sperm cannot fertilise an egg when the motility in the sperm is diminished.”
In order to investigate male factor infertility, semen analysis is the first step. It is a simple and helpful test. According to the World Health Organisation (WHO), male factor infertility is caused by sperm disorders. The cut-off values are as follows; sperm concentration >15 million sperm/ml (oligospermia), total sperm motility <50 per cent (asthenospermia), and normal forms <4 per cent (teratozoospermia).
Dr Allahbadia, Mumbai based IVF expert informs, “Data suggest that in couples with mild oligospermia (10-15 million sperm/ml), IUI improves pregnancy rates. However, there is little agreement about what predicts pregnancy outcome in various seminal abnormalities.” He adds, “A study of male infertility treated with IVF provided insight into the treatment of moderate oligospermia (5-10 million sperm/ml). The fertilisation rate of the oocytes was significantly lower in cases of severe oligospermia (for example, < 5 million sperm/ml) and poor sperm motility.” Infertile men with very severe oligospermia, asthenospermia, teratozoospermia, or even azoospermia have seen a dramatic improvement in their survival rates after intracytoplasmic sperm injection (ICSI) of their sperm.
If the total motile sperm count > or = 5 million/mL and initial sperm motility are at or above 30 per cent, then intrauterine insemination is an effective therapy for male factor infertility. When these initial values are lower, IUI has little chance of success.