Intrauterine insemination, step by step

Intrauterine insemination (IUI) is often the first assisted procreation procedure used in the treatment of infertility. The homologue IUI principle is based on the injection of sperm from a partner into a woman’s uterine cavity.

The purpose of IUI is to facilitate the meeting of spermatozoa with eggs and thus increase the chances of pregnancy. IUI is a simple procedure that can be used in certain situations:

Unexplained infertility.
Infertility is associated with certain medical causes of women (eg, minimal to mild endometriosis with at least one fallopian tube, permeable anterior cervix, etc.).
Male infertility is associated with a slight or moderate decrease in sperm concentration and / or motility.
Infertility due to the impossibility of sex (eg erectile dysfunction, vaginismus, psychogenic factors, etc.).
The IUI process requires control of two important parameters for its success: the time of insemination and preparation of spermatozoa.

Moment of insemination
To allow sperm and egg cells to meet, IUI must be done in a period close to ovulation. To determine when an eviction will occur, there are two main methods of synchronization: a urine test for ovulation detection or ultrasound monitoring for ovarian follicle maturation.

Urine ovulation test is the simplest and most practical method. This test is available at Fertilys, at pharmacies or in supermarkets. Usually it can be done at home. The principle of this test is based on the detection of luteinizing hormone (LH) in urine. LH peaks usually occur 24 to 36 hours before ovulation, making it possible to estimate when the eggs will be fertilized.

Ovulation can also be determined by ultrasound monitoring. Through a series of ultrasounds, we can visualize the number of developing ovarian follicles and observe the evolution of their size. When the dominant follicle reaches a size between 18 and 25 mm, ovulation can be artificially triggered by injection of the chorionic gonadotrophin (hCG) hormone. In fact, hCG mimics the pre-ovulatory peak of LH. HCG will induce ovulation to replace the naturally secreted LH. Ovulation occurs around 36 hours after injection, so an appointment for an IUI is scheduled the next day or two days later.

Award: Dr. J. Herrero Garcia
Preparation of spermatozoa
At IUI, sperm are stored directly into the uterine cavity, allowing them to pass through the cervix without difficulty. To do this, sperm must first undergo adequate preparation which will ensure better success during insemination.

When a sperm sample is produced by a partner, it must be thawed before being processed. Generally it is recommended to produce samples on site at the clinic. Then placed in an incubator at 37 ° C for 30 minutes to make it melt.

If the sample is produced at home, it must be transported at body temperature, under the armpit or in the stomach, to maintain its optimal integrity and allow it to thaw. In the laboratory, after thawing, a drop of sample is first stored on a counting slide that allows the concentration and mobility of spermatozoa to be evaluated under a microscope. The remaining sample is stored in solution, in the form of an increase in density gradient, which will allow the motility of spermatozoa to be concentrated at the bottom of the tube, by centrifugation (Figure 1). Once concentrated, motile spermatozoa are stored in a washing solution that removes semen and seminal fluid. It should be noted that seminal fluid must be removed from the preparation because it can cause uterine contractions and put the woman at risk of pelvic infection after insemination. After completion, the solution containing motile sperm is sucked into a flexible tube called a “catheter”. Insemination will then be carried out by the doctor and spermatozoa will be stored in the uterine cavity via a catheter (Figure 1). Catheter insertion is directed after speculum insertion, and the procedure usually does not cause major discomfort. Insemination will then be carried out by the doctor and spermatozoa will be stored in the uterine cavity via a catheter (Figure 1). Catheter insertion is directed after speculum insertion, and the procedure usually does not cause major discomfort. Insemination will then be carried out by the doctor and spermatozoa will be stored in the uterine cavity via a catheter (Figure 1). Catheter insertion is directed after speculum insertion, and the procedure usually does not cause major discomfort.

When combined with ovulation stimulation, IUI is more likely to succeed. According to research, the success rate of insemination varies between 10 and 15%. One third of women under 40 years will get pregnant during the first 3-4 cycles of their insemination. If

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