Protocols for IUI - Rama Sofat Hospital

Protocols for IUI

The IUI can be done in a natural cycle or stimulated cycle

1. In Natural cycle or unstimulated cycle, IUI is timed to take place at the time of natural ovulation. Ovulation is detected using ovulation predictor kits or serial blood tests or serial ultrasound scans usually between 12 to 16th day of the menstrual cycle
2. In Stimulated Cycle, single or multiple egg formation is achieved through drugs such as Clomiphene Citrate, Gonadotrophins(FSH or HMG) alone or in combination with clomiphene or GnRh analogues. The basic requirement for most ART treatments is formation of more than one mature egg, as this is generally associated with improved chances of conception. The growth of the eggs is observed via vaginal sonography that shows follicle size and count. Occasionally a blood level of serum Estadiol hormone (E2 Level) may be done. Once two leading follicles have reached a size of 1.8- 2 cm, HCG injection is given to bring about ovulation and IUI is done after 36 and 48 hours of giving the injection

IUI at Dr. Rama Sofat Hospital: Normally our unit does 2 IUI cycles using Clomiphene. If this fails to achieve pregnancy, we use a combination of Clomiphene with Gonadotrophins(FSH) and try out 2-3 cycles. If this fails to achieve pregnancy, we try out 2 cycles with pure Gonadotrophin drugs, with or without GnRH analogue. In case this also fails, we go for either IVF or ICSI treatment.

Semen Production
The husband is given a sterile container, and he is asked to give his semen sample by masturbation in a semen collection room. He can even give the sample at home and reach the clinic within a period of 30 minutes. In case of difficulty in ejaculating, many other options may be tried out but it is necessary not to use any lubricant, including soap for semen production

Semen Preparation:
The semen is processed in the laboratory using specially imported culture media. The semen can be processed and washed either by the standard swim-up method or the density gradient method. The seminal fluid is discarded and the best quality motile sperms are separated. These are then floated in 1/2 to 1 ml of culture media, which is then used for insemination.

Insemination:
The procedure of IUI takes about 2 hours from the time semen is produced till the IUI is done. The patient is placed on the table. Speculum is inserted and cervix exposed. The cervix is cleaned with saline. The sperm suspension is then taken in a syringe to which a thin cannula is attached. The cannula passes through the cervix into the uterine cavity and gently deposits the sperm suspension. The procedure is painless and takes about 5 minutes after which the patient is made to lie for another 15 minutes and then sent home. The rationale for doing an IUI is that the effect of vaginal acidity and cervical mucus hostility can be decreased. A washed sample has more number of highly motile good quality sperms and also the chances of having uterine cramps and infections are significantly reduced.

Success Rate:
The best results are seen among patients with cervical factors and in IUI's done using donor semen. The success rates vary from 15-25% per cycle. This means that after about 6 months of treatment, 4 to 6 patients out of 10 would have become pregnant. The remaining would need advanced procedures like IVF or ICSI to achieve a pregnancy.

POST IUI MEDICINE
Generally following an IUI procedure the patient is given a mild antibiotic along with Luteal support in the form of oral progesterone/varginal pessaries for 2 weeks. After 14 days a blood test (B-HCG) is done to confirm her pregnancy. In case pregnancy ensues luteal support is continued for another 2 weeks.

- Rama Sofat Hospital