- What is IUI?
Intrauterine insemination (IUI) is a type of artificial insemination in which there is a transfer of many motile (actively swimming) sperm, through the cervix and directly into the uterus.
- Why is IUI performed?
IUI can be performed depending on the age and reproductive health of the woman.
- Lack of conception after a woman has been on ovulation enhancing agents. This can be particularly important when taking Clomiphene since it can cause decreased cervical mucus
- Cervical factor
- Mild to moderately abnormal semen parameters can be an indication for IUI
- Unexplained infertility
- Minimal – mild endometriosis
- Advancing maternal age
- Male ejaculatory dysfunction
- Use of frozen sperm
- When donor sperm needs to be used
- How is an IUI performed?
An IUI is performed by threading a very thin flexible catheter through the cervix and injecting washed sperm directly into the uterus. It usually requires the insertion of a speculum and then the catheter. The whole process takes only a few minutes.
- When is the best time to do an IUI?
Ideally, an IUI should be performed around the time of ovulation. When timing is based on an hCG (human chorionic gonadotropin) injection, the IUI’s are usually done between 24 and 48 hours later. If two IUI’s are scheduled, they are usually spaced at least 24 hours apart.
- Where is the sperm collected? How long before the IUI?
Usually, the sample is collected through ejaculation into a sterile collection cup. Most clinics want the semen to be delivered within a half-hour of ejaculation, around the time of liquefaction, so if one lives close enough the sample can be collected at home.
There will delay between when the semen sample is given for washing and when it will be inseminated. The amount of time depends on the washing technique used, which takes 30 minutes to two hours. Most will perform the IUI as soon after washing is completed as possible.
- How long does washed sperm live?
Current research indicates that washed sperm can live 24-72 hours; however, it does lose potency (ability to fertilize the egg) after 24 hours. Another issue with Intrauterine insemination (IUI) is that the sperm can keep on swimming beyond the fallopian tube, so the ideal window is really within 6-12 hours of the egg being released, with a larger margin before ovulation than after since the egg’s viability is shorter. Sperm can live up to 5 days in fertile mucus, 2-3 days being pretty common, so combining IUI with intercourse may provide better coverage.
- How long do I have to lie down after an IUI?
It is advisable to lie down for 30 minutes after the procedure.
- Do I need to rest after an IUI?
Most people don’t need to, but if you had cramping or don’t feel well afterward it makes sense to take rest for a while. Some people reduce their aerobic activity and lifting heavy weights during the luteal phase, in the hope that it will increase the chance of implantation.
- How long before an IUI should the male abstain from intercourse/ejaculating and store up sperm?
This depends on your individual situation, but it usually should not be more than 72 hours since his last ejaculation in order to ensure the best motility and morphology. Where low sperm count is the reason for IUI, it is generally best to wait 48 hours between ejaculation and collecting sperm for the IUI. With no sperm count issues, it makes sense to wait at least 24 hours.
- How soon after an IUI can I have intercourse?
Usually, you can have intercourse anytime after an IUI. In fact, most doctors suggest having intercourse, when that is an option, soon after the last IUI to help make sure ovulation is covered. The best fertility doctors may suggest waiting 48 hours to resume relations if you had any bleeding during the IUI.
- What are the risks involved in IUI?
The main risks are some discomfort such as cramping, a minor injury to the cervix that leads to bleeding or spotting, or the introduction of infection. There are also risks of hyperstimulation associated with the use of ovulation induction medications such as clomiphene citrate (low risk) and gonadotropin therapy (higher risk). Proper technique and adequate monitoring reduce risks.
- When will I have to test for pregnancy after an IUI?
The pregnancy test should be done 2 weeks after an IUI.
- What is In-Vitro Fertilization (IVF)?
IVF (In-vitro fertilization) or test tube baby as it is commonly called is a procedure in which the eggs and the sperms are fertilized outside the body and then transferred back to the womb after 2-5 days.
- Who needs an In-Vitro Fertilization (IVF)?
IVF may be considered if,
- You have been diagnosed with unexplained infertility.
- Your fallopian tubes are blocked other techniques such as fertility drugs or intrauterine insemination (IUI) have not been successful.
- Other techniques such as fertility drugs or intrauterine insemination (IUI) have not been successful the male partner has fertility problems and an abnormal semen analysis.
- The male partner has fertility problems and an abnormal semen analysis.
- You are using your partner’s frozen sperm in your treatment and IUI is not suitable for you.
- You are using donated eggs or your own frozen eggs in your treatment.
- You are using embryo testing to avoid passing on a genetic condition to your child.
- If you have severe endometriosis.
- What do I expect during my test tube baby treatment cycle?
Your IVF/ Test tube baby treatment cycle would be as follows,
Step 1: Once you have decided to go ahead with IVF, you will undergo a daycare procedure called hysteroscopy to assess the suitability of the uterus to hold the baby. It is generally done one month before your IVF cycle and involves the introduction of a small camera into the womb through the vagina to visualize the inside of the uterus. You will be given anesthesia during the procedure and hence there will be no pain.
Step 2: Your husband has to freeze one semen sample as a backup.
Step 3: Typically your treatment would begin on the second or third day of periods. It involves a scan and hormone tests followed by daily injections for about 8-10 days, along with monitoring by scan and hormone tests in between. Once the eggs are sufficiently grown as per the scan and hormone tests, you will receive injection Hcg as an ovulation trigger.
Step 4: Egg retrieval is performed transvaginally 35 – 36 hours later, with light anesthesia, using transvaginal ultrasound guidance. You will be discharged the same evening unless there are problems associated with bleeding, undue pain or ovarian hyperstimulation.
Step 5: After retrieval, eggs are assessed for their maturity. Meanwhile, the husband has to give a fresh semen sample. Mature eggs are injected with the sperms on the same day and grown in the incubator for 3-5 days.
Step 6: The final step is the embryo transfer. 3-5 days after your egg retrieval, two or three embryos are selected and gently transferred into the womb using abdominal ultrasound guidance. The procedure is usually painless, no anesthesia is required and you will be discharged in about two to three hours.
Step 7: You will be given certain supportive medications starting from the day of egg retrieval until your pregnancy check. You will be called for a pregnancy check 16-17 days after your embryo transfer.
- What precautions do I take during the In-Vitro Fertilization (IVF)/ Test tube baby treatment?
- Eat a healthy diet rich in fruits and vegetables
- Be stress-free and relax your mind
- Avoid intercourse during the treatment.
- Don’t do a strenuous job during the treatment as your ovaries are enlarged and they may twist sometimes causing acute pain.
- How do I prepare myself for an egg retrieval procedure?
- You will get admitted to the hospital early in the morning, between 6 am – 7 am and you have to be empty stomach at least 6-8 hours before the procedure.
- You will be administered light anesthesia as intravenous medication.
- The procedure is done vaginally using the scan guidance and a small needle.
- The entire procedure takes about 20-30 minutes.
- Post-procedure you may have slight pain or bleeding which usually subsides with medication.
- You will be discharged about 6 hours later.
- What do I expect during embryo transfer?
It is done 3-5 days following the egg retrieval, which will be decided by your clinician. No anesthesia is required as it is a painless procedure. Rarely during your initial assessment, if it is found that getting into the uterus is difficult or if you are very uncooperative, you may be given light anesthesia. Your bladder has to be full before the procedure as it is done under abdominal scan guidance. Do not wear perfume/ deodorant or powder on that day as they are harmful to the embryos. Two or Three embryos are gently transferred to the uterus using a small catheter. You will lie down for about 15 – 30 minutes after the procedure and later you can pass urine. No need to take bed rest until your pregnancy check. This does not increase your chances of becoming pregnant.
- What is ICSI? How does it differ from In vitro fertilization (IVF)?
ICSI – Intracytoplasmic Sperm Injection, is an IVF procedure in which a single sperm is injected directly into an egg whereas in IVF, about 50,000 to 1,00,000 sperms are inseminated around the eggs and one of them penetrates the egg on its own. ICSI increases the fertilization rates especially in male factor infertility and cases of previous fertilization failure.
- What is the success rate of test-tube baby?
The success rate varies with multiple factors especially the age of the women, egg and the sperm quality and the underlying cause of infertility. Overall the success varies between 40-50 %. Success decreases as the age of the woman increases.
- What is the frozen embryo transfer?
Surplus embryos after your transfer can be frozen and kept in liquid nitrogen at -180 degree Celsius, for later use.
- What are the complications?
Two most important complications of In-Vitro Fertilization (IVF) are
- Multiple pregnancies (20-25%).
- Ovarian hyperstimulation syndrome which occurs due to excessive response and can be prevented b appropriate modifications in the medications.
- Rarely ovaries may twist causing acute pain and may require a laparoscopy.
- When can I know if I have become pregnant?
You will be tested for beta HCG – a blood test to confirm pregnancy 14 to 16 days after your embryo transfer.
There is no evidence to show that IVF babies have an increased rate of abnormalities. The pregnancy outcome will be like a normal conception but your doctor may have a low threshold for intervention when the problem arises.
- Fertility: assessment and treatment for people with fertility problems.NICE clinical guideline;– Issued: February 2013.
- van Loendersloot LL, van Wely M, Limpens J, Bossuyt PM, Repping S, van der Veen F (2010). “Predictive factors In-Vitro Fertilization (IVF): a systematic review and meta-analysis”. Human Reproduction Update 16 (6): 577–589.
Men and women are affected by infertility in different ways.
Most couples experience the struggle in much the same way. This is related to the traditional ways men and women have been trained to think, feel and act. Women are typically seen, by others as well as themselves, as the emotional caretakers or providers of the relationship.
Women typically feel responsible not only for everyone’s bad feelings but also for anything bad that happens. When women try to repress feelings, their emotions can become more ominous until they finally feel out of control. Their emotions can become a monster about to swallow them whole.
Women in infertile couples often protect their husbands from their own pain and feelings of failure by taking much of the responsibility for the treatments upon themselves. When it is suggested that men accompany their wives for appointments, couples get concerned about issues like income loss, use of time, etc. While these concerns are usually relevant and important, they also serve the purpose of protecting husbands from their own responsibility in the conception process and from their own feelings, which could easily be intensified by so much contact with the medical process.
Men are traditionally seen as the financial providers of the relationship and are responsible for protecting the family from real or imagined dangers. Men usually feel more threatened expressing themselves since they have often been conditioned to repress their emotions. They are trained to be more instructional to take charge, to make decisions and to think without being sidetracked by emotions.
Males in infertile couples often feel overwhelmed by the intensity of their partner’s emotions as well as an inability to access their own. They tend to focus their energy back into their work, a place where they feel they can have more success.
Impact of Infertility in Women
As a result of taking responsibility for the emotional impact of infertility, the woman experiences intense feelings, such as pain, anger, fear, etc., which, combined with the messages that her way of dealing with things is in some way dysfunctional or “crazy”, causes her to feel an anxious depression. As feelings spill out, she feels out of control and doesn’t really know how to ask for what she needs, especially from the husband she is struggling so hard to protect. She may yearn for an emotional connection/interaction at one moment and in the next withdraw emotionally from her husband when she fears she has disappointed him.
Men find themselves in a position where, regardless of how well they’ve been trained to solve problems, they are helpless to make this situation better for the woman and, as a result, may give off messages that she is “too” emotional or sensitive, hoping that this will calm her down. The wife hears this as a criticism of her coping and caretaking skills rather than as an expression of her husband’s fears.
This is the time when couples cling together for dear life, feeling that they’ve failed in the most basic of all roles: reproduction. Couples are hesitant to admit problems in their marriage, feeling that having difficulty coping would mean that their marriage is also a failure.
Luckily, there are ways that men and women can help each other balance thinking and feeling as they struggle side by side on their journey toward parenthood.
The questions then arise:
- How do I get what I need from my partner?
- How can I support my partner during this difficult time?
Here are some suggestions to help both partners during the infertility process:
- Communicate openly with each other.
- Realize there’s no right or wrong way to feel. Getting in touch with your feelings will help you know what you need. Once needs are identified, clearly and specifically tell your partner how to help you.
- Ask your partner what she/he needs rather than assuming that you can/cannot give it.
- Recognize the psychological and emotional differences between men and women.
- See if you can teach each other some of the skills you’ve learned from your own life experiences as a man or woman.
- Share more in the process of treatment. Share both the burdens and joys of your different perceptions/experiences of infertility. It will help to balance the intensity and bring you closer with a deeper respect for each other.
1. Prickling, tingling nipples
As pregnancy hormones increase the blood supply to your breasts, you may feel a tingling sensation around your nipples.
This can be one of the earliest symptoms of pregnancy and is sometimes noticeable within a week or so of conception. Once your body gets used to the hormone surge, this sensation will subside.
The process of IVF(In-Vitro-Fertilization) involves the ovarian stimulation with hormones with the intention of retrieving more eggs. The whole idea is to have enough eggs to produce an optimum number of good embryos to transfer and to freeze a few in case the fresh transfer fails. The question here is how many do we actually need? What is the optimum number of eggs needed to achieve a live birth, which in turn is the ultimate aim of IVF?
Does the collection of eggs increase the chance of pregnancy?
The higher number of eggs retrieved is associated with a probability of more chromosomally normal (euploid) embryos which can implant and give rise to a living birth. Chromosomally abnormal embryos (“aneuploid”) are unlikely to develop as pregnancies, and, if they do, frequently result in miscarriage. The frequency of chromosomally abnormal embryos increases with age and thus the pregnancy rates decrease with age. To produce one and two euploid embryos respectively, five and 14 oocytes would be required at age 34, while 10 and 24 oocytes would be required at age 38. Thus it makes sense to retrieve more eggs.
But this comes at a cost .. To retrieve more eggs often we have to use a higher dose of hormones increasing the cost as well as the side effects. It also leads to a potentially serious complication of ovarian hyperstimulation where they collect fluid in the abdomen, lungs and also susceptible to hypotension, increased clotting tendency and at times renal shutdown. The excessive ovarian response can also cause the enlarged ovaries to twist on its pedicle, cutting off its blood supply – what we call as ovarian torsion. This is an acutely painful condition which requires immediate medical and surgical attention. Another reason for concern is the compromised egg quality for unknown reasons when there is an excessive ovarian response. The raised estradiol hormone in case of excessive ovarian response advances the implantation window, thereby causing an asynchrony between the embryo and the endometrium (uterine lining), ultimately decreasing the implantation rates.
Frozen Embryo Transfer
So our aim in IVF cycle is to retrieve anywhere between 8 to 15 oocytes, so as to consider a fresh embryo transfer and also to expect a reasonably good pregnancy rate. Studies have proven that pregnancy rates steadily increase till 15 oocytes and thereby it decreases. When there is hyperresponse we may have to defer embryo transfer and freeze all embryos to avoid potential complications of ovarian hyperstimulation. They can be transferred at a later date after preparing the endometrium – Frozen Embryo transfer.