Intrauterine insemination (IUI) comes under the methods of assisted reproduction. It is suitable for couples which have difficulty to conceive due to the reduced number or motility of sperms, but also when woman produces antibodies against sperms. In this case, sperm can not pass through uterine cervix on their way from the vagina into the uterus and further to fallopian tubes, this is caused by the immune system of woman. It is necessary that the woman has at least one passable oviduct for successful preformation of this method. Infertile couple has to go through several tests and according to them the appropriate method of assisted reproduction is advised.
Activity of the female reproductive system manifests as ovarian and menstrual cycle. These two cycles are hormonally controlled by the brain with two main hormones, follicle stimulating hormone (FSH) and luteinising hormone (LH), which directly stimulate the growth of eggs in the ovaries. In the course of one cycle is always only one ovary active but the ovaries alternate each month. The eggs mature in the ovaries during the cycle. One of them gets ascendant and the others are perished. During the growth of eggs the ovaries produce more hormones, called oestrogens. Their function is to prepare the uterus to receive the fertilized egg. When the egg is matured ovulation occurs. The ovulation is process in which comes to the rupture of egg's protective packaging and the egg is release into the fallopian tube. Ideally, the egg is fertilized by sperms and then it may move further towards the uterus in which is it nidated. However, if any of these processes are impaired, fertility disorders develop.
Infertility is defined as the inability of couple to conceive a child with regular unprotected sexual intercourse within two years. It is reported that 40% of infertility cases are due to female factor, male factor plays role in 40% of infertility cases and rest 20% of cases is the fault in both partners. In addition to stress, lifestyle and increasing age is female infertility also caused by various diseases which develop failure in the release of egg and its nidation. These include the impairment hormones, ovarian function, damaged fallopian tubes which may be impassable, developmental defects and disorders of the uterus in which, for example, is the egg not able to nidate or the disorders of immune system which fights against sperms or the fertilized egg. In men, infertility is caused by insufficient amount of viable sperm.
Process of intrauterine insemination
If the couple decides, according to the recommendation of doctors, for intrauterine insemination or IUI, man provides sperm sample for the sperm count. The sperm count is an investigative method in which is the quality of sperms checked under the microscope. The procedure of intrauterine insemination or IUI itself is performed on the day when the woman ovulates. The procedure is completely painless and is done ambulatory. That day is also men's sperm taken. For best results, it is recommended to have at least 3 days of sexual abstinence. After the collection, semen is processed with special technique in the laboratory. During this process are sperms separated from the liquid ejaculate due to possible allergic reactions to this fluid. From the sample are selected healthy, fast-moving sperms with the good quality of movement. Afterwards, thin catheter or tubing is introduced through the cervix into the uterus and about 0.5 to 1 ml of sperms solution is injected as far as possible. This way is route of sperms which must they travel before they reach the egg shortened and the chances of fertilization are increased. After this intervention, the women should remain for few minutes in rest and then is she free to go. Even the incapacity benefit is not necessary. After fertilization, woman still takes sex-hormones, i.e. progesterone which function is to promote and maintain the pregnancy. The hormone tablets can be taken orally or by introduction into the vagina. The second method is preferred more because the hormone is better absorbed and also its local effect is beneficial for the uterus.
Efficiency of intrauterine insemination
The whole process of insemination has very low risk. Its efficiency is not so high, it does not exceed 12%. Every woman is entitled to 6 IUI per year, thus they are covered by her insurance company. IUI is normally performed three times with the two applications of semen in two-day interval. The only additional charges are for hormonal treatment. Usually, it is stated that if pregnancy is not achieved after two series of IUI, another method of assisted reproduction should be recommended to the couple. For example, in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) is recommended. In IVF are the eggs taken from the woman and they are fertilized with sperms of partner or donor in the laboratory, afterwards, the eggs are returned into the woman's uterus. The second method ICSI is also performed in laboratory conditions in which are into the harvested female eggs injected healthy male sperms through thin needle and the fertilized egg is then returned to the uterus.