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    intrauterine insemination (iui)

    Intrauterine Insemination (IUI) - Success Rate, Preparation, Cost And Side Effects

    • 38811 views
    • 4.5   (5 Votes)
    Medically Reviewed by Dr. Deepika Tiwari - MS, MBBS on 30 Mar 2019 - Written by Dr. R K Sharma - MD, MBBS - Grammatically Approved by Dr. Kavita Jaggi Agrawal - MS, MBBS

    IUI is used for couples with unexplained infertility, minimal male factor infertility, and women with cervical mucus problems. IUI is a safe procedure and younger women have higher chances of success with IUI. The cost of IUI in India can range anywhere between Rs. 3000 to Rs. 10,000.

    Intrauterine insemination or IUI is the placing of sperm into a woman’s uterus when she is ovulating. This procedure is often done in conjunction with ovulation-stimulating drugs. Intrauterine insemination can be performed using the husband’s sperm or donor sperm. Before IUI, the woman should be evaluated for any hormonal imbalance, any structural problems or any infections. Insemination is performed at the time of ovulation, usually within 24 to 36 hours after the LH (leutenizing hormone) surge is detected, or after the trigger injection of hCG (human chorionic gonadotropin) is administered. Ovulation is predicted by a urine pregnancy test kit or blood test and ultrasound. (1)

    In this article we will look at:

    1. Who are the beneficiaries of IUI in India?

    The beneficiaries of IUI include those who have:

    • Unexplained causes: The most common use of IUI is when there is unexplained infertility. Infertile women can take medications by mouth or as an injection that cause their ovaries to mature several eggs at once.
    • Cervical stenosis or abnormalities: IUI is useful when a woman’s cervix has scarring that prevents the sperm from entering the uterus from the vagina. This is common among women who have had surgery on their cervix (cryosurgery, cone biopsy, Loop Electrosurgical Excision Procedure [LEEP], etc.). 
    • Problems with sperm delivery: IUI is used for couples when the male partner cannot stay erect or is not able to ejaculate effectively, or at all. IUI is useful if the man has an abnormal urethral opening (opening of the penis).
    • Lack of ovulation or anovulation:Most of the time women who do not ovulate regularly can become pregnant through intercourse. In such cases, IUI may be helpful.
    • Fertility preservation: Men may collect and cryopreserve their sperm for future use before having testicular surgery, vasectomy, or radiation/chemotherapy treatment for cancer. The sperm may be thawed and used later for IUI.
    • Third-party reproduction:IUI is also used when couples use sperm from a man who is not the woman’s partner to have a baby. This is called donor insemination (DI). DI is done when the male partner has no sperm or when the sperm quality is so low that his sperm cannot be used for conception and IVF (In Vitro Fertilization) is not an option. (2)

    2. When is IUI not recommended?

    • Women who have severe disease of the fallopian tubes
    • Women with a history of pelvic infections
    • Women with moderate to severe endometriosis

    3. How safe is IUI?

    Generally, IUI is a very safe procedure. The only problem is the risk of multiple pregnancies (twins, triplets or more), which can pose some serious health problems to both the mother and the baby. It can result in premature or low birth weight or even death in some cases. The risk of multiple pregnancies, however, depends on the number of follicles present. This will be affected by whether the patient is taking fertility drugs. If patients are dependent on fertility drugs it is vital that they scan to check the number of follicles and if there are more number of follicles treatment should be stopped. As the IUI procedure also involves the process of passing a thin catheter into the womb through the cervix there may be some risk associated with it. Some patients may experience pain during the procedure. The risk of the procedure involves infection or injury in the cervical area. This can lead to cramping, spotting and bleeding during the procedure. (3)

    4. How successful is one cycle of IUI?

    As with any fertility treatment, the younger the woman is the higher are her chances of getting pregnant. Patients are also more likely to get pregnant if they have fertility drugs to stimulate their natural cycle. For women under the age of 35 years, about 14 percent of IUI cycles result in a pregnancy (a cycle is one full round of IUI treatment). Women aged between 35 to 37 years get pregnant in around 12 percent of cycles and the success rate for women aged 38-39 is 10 percent. For women over 40 years, the chances are lower (6 percent for women aged 40 to 42 and 3 percent for women aged over 42). (4)

    5. How to prepare for IUI?

    • Preparing the semen sample. Firstly a semen sample is collected from the partner at the doctor's office. A vial of frozen donor sperm that can be thawed and prepared – can also be used. As non-sperm elements in semen can cause reactions in a woman's body that interfere with fertilization, the sample is washed in a way that separates the highly active normal sperm from lower quality sperm and other elements. The likelihood of achieving pregnancy increases by using a small or highly concentrated sample of healthy sperm. (5)
       
    • Monitoring for ovulation. If patients are self-monitoring, then they are suggested to use an ovulation predictor kit from any local pharmacy. Patients are not recommended a specific brand, but using a kit that detects the luteinizing hormone (LH) surge via urine sample may be the best option. In case patients are asked to visit the clinic for monitoring, they are usually asked to visit once between Days 2 – 5 of their cycle for baseline blood tests. Patients may be asked to return 2 – 6 more times after starting medications. The number of visits will be determined by how their body is responding to the medications and cannot be predicted in advance. If patients are monitoring at home, they will know they are nearing ovulation when the LH surge is detected. If patients have been using injectable gonadotropins, they may also be prescribed an injection that makes them ovulate and is timed to work with timed intercourse or IUI procedure to improve fertilization results. Prior to ovulation, patients are instructed on the timing of intercourse with their partner and/or scheduled to come in for an IUI procedure. For the process of IUI, a washed sperm sample is placed directly into the uterus, increasing the number of sperm in the reproductive tract and fallopian tubes where fertilization usually occurs. It is especially helpful for male factor infertility issues, including low sperm concentration, low semen volume or decreased sperm motility. Unless otherwise indicated due to male factor fertility issues, couples are encouraged to engage in intercourse during the first half of the cycle and the day immediately following an IUI. The physician will be monitoring their response to prescribed medication(s) through blood testing and ultrasound. Once in the cycle, patients are required to visit the clinic for blood work and ultrasound, which is often called a “Morning Monitoring”. If the male partner is not available to produce a fresh specimen due to travel or other commitments, he should freeze a sample prior to the start of their ovulation induction cycle. (6)
       
    • Determining optimal timing. Most IUIs are done a day or two after detecting ovulation. Your doctor should have a plan spelled out for the timing of your IUI.

    6. What happens during the process of IUI? 

    Several steps are involved the day of the IUI procedure.

    • Recently, research was done to evaluate the impact of IUI timing performed 24 or 36 hours later following ovulation trigger. The evaluation was done on clinical pregnancy rate during ovulation induction with clomiphene citrate among infertile women. The medical records of 280 infertile patients who have undergone ovulation induction by using clomiphene citrate have been evaluated. The cycle outcomes of the patients have been investigated specifically based on the timing of IUI during the treatment cycle. The clinical pregnancy rate of the study group based on the timing of IUI (24 vs. 36 hours following the hCG trigger) was found to be similar regardless of infertility type. The cycle day of which hCG (human chorionic gonadotropin) trigger has been performed was found to be significantly longer for patients who have achieved clinical pregnancy compared to patients who have not got pregnant after the treatment cycle. It was found that IUI timing did not affect the cycle outcomes whether the procedure has been performed 24 hours or 36 hours later following ovulation trigger with exogenous hCG utilization. The longer period of treatment cycle during ovulation induction with clomiphene citrate resulted in higher clinical pregnancy rate. IUI can be done successfully at either 24 or 36 hours after hCG in clomiphene citrate-stimulated cycles. (7)
    • If the sperm sample comes from a donor, the sample will be thawed and then processed. Most clinics usually process the sperm sample to increase the available sperm and the chance for conception.
    • The setup of the insemination is similar to a Pap smear. The cervix is cleansed with a cotton swab and a small catheter about the diameter of a coffee straw is placed into the vagina and past the cervix so that the sperm goes into the uterus. The procedure causes little or no pain and only takes only a few minutes.
    • After the catheter and the speculum are removed, patient reclines on the exam table for 10-15 minutes. This period of lying down actually improves the rates of pregnancy. However, research shows no additional benefit is achieved by resting longer than that time. Patients can return to normal activities once they leave the fertility clinic. The total time patients might spend in the fertility clinic can range from 30 minutes to two hours.
    • Patients may experience some cramping and light vaginal bleeding after the procedure. Most women do not experience any additional symptoms.
    • After two weeks, patients take a pregnancy test at home. (8)

    7. What are the costs of IUI cycles in India?

    The cost of IUI in India is very low as an IUI cycle can cost as little as Rs. 3,000. However, even if patients require just one cycle, they may spend between Rs. 5,000 and Rs.10,000 as they may require ultrasounds and other tests before the IUI treatment process can begin. However, when one considers that a couple can expect to spend between 3 and 5 lacs on IVF treatments, it is easy to see why IUI is a more popular option. Just as all medical costs vary from one state to another and from one city to the other, the IUI Cost in India can also vary greatly depending on the location. This is because the IUI cost in Gurgaon is quite different from the IUI cost in Chennai. Similarly, the cost of IUI in Mumbai would be very different from the cost of IUI in Bangalore or Hyderabad. Here are indicative costs of IUI treatments in various Indian cities:

    City                                                               

    Average Cost per IUI Treatment Cycle

    (Not inclusive of Stimulation medication costs, In Rupees)

    Mumbai                       

     Rs. 10,000 - Rs. 15,000

    Bangalore                   

    Rs. 8,000 - Rs. 9,500

    Delhi

    Rs. 6,000 - Rs. 8,500

    Chennai

    Rs. 4,000 - Rs. 5,000

    Nagpur

    Rs. 3,500 - Rs. 5,000

    Hyderabad                      

    Approx. Rs. 4,000

    Pune

    Approx. Rs. 4,000

    Kolkata

    Approx. Rs. 4,000

    8. What are the factors that influence the costs of IUI?

    IUI costs vary from one couple to other, as tests, treatment plans, and medications would differ according to the couple's age and medical history. Given below are some of the factors that influence the cost of IUI treatment plan:

    1. Number of cycles required: The chances of pregnancy with 1 cycle are 10 percent - 20 percent for women who are less than 35 years old, 10 percent for women between the ages of 34 and 40 and 2 percent to 5 percent for women over 40 years. Patients are charged per IUI treatment cycle, so the more cycles they require, the higher the cost of IUI. A woman's age is the most important factor in determining IUI success rates. This is why IUI success rates are higher for younger women which means that their IUI costs are lower. Typically, doctors recommend that a couple move on to IVF after 3 failed IUIs. However, if a female is under 30 years of age or if the fertility problem is because of a lack of ovulation, the doctor may suggest one or two more treatment cycles and this would then increase the amount patients have to spend on their IUI treatments.
    2. Medications for ovarian stimulation: Oral medications for ovarian stimulation are much cheaper than the injections and can range from Rs. 650 to Rs. 6,500 per cycle. IUI costs can go up depending on whether patients require medications or injections for ovarian stimulation. For instance, the cost of the medication clomiphene can range from Rs. 650 to Rs. 6,500 depending on the required dosage but the average amount spent on this medication during a single IUI cycle is Rs. 2,500.
    3. Injections for ovarian stimulation: A single vial of either of these injections costs Rs. 500 but patients may require multiple shots, which can substantially increase the IUI costs. A doctor may recommend human chorionic gonadotropin (hCG) or Follicle stimulating hormone (FSH) for egg stimulation and to boost fertility levels. It is possible for the total IUI treatment cost to go up to as much as Rs. 20,000 for a cycle.
    4. Ovulation & follicle monitoring: Follicle monitoring can be carried out through blood tests that determine the woman's levels of estrogen, luteinizing hormone, and progesterone. The doctor can also ask for a vaginal ultrasound to measure the actual size and shape of the follicle. If the follicle is found to be underdeveloped, medication can be prescribed to improve the maturation process so that it reaches the optimal size and shape. An ovulation predictor kit generally costs around Rs. 500 but the costs of vaginal ultrasound can range from Rs. 2,000 to Rs. 6,000 depending on the location as well as the clinic where it is performed. (9)

    9. What are the side effects of IUI?

    The side effects of IUI procedure are very less or minimal. Some women report mild cramping during and after the IUI while many report little to no pain during the procedure. In some cases, a vaginal infection may occur due to the introduction of bacteria. This may cause itching or burning, discharge, and a foul odor. In rare cases, spotting or bleeding may occur if the cervix is injured during the procedure. (10)

    10. What are the medications that can increase the success rate of IUI?

    Studies suggest that IUI success rates are enhanced if a patient also undergoes moderate treatment with medications. A decision to take medication to stimulate ovaries is made in consultation with the concerned doctor. Most patients start with either clomiphene citrate or Letrozole oral medications, taken for five to six days shortly after menstruation begins. Alternatively, patients might be advised to take injectable fertility drugs, which are more aggressive in stimulating multiple egg release. The more eggs are produced during a treatment, the higher their chance for success, but the chances of multiple pregnancies also shoot up. (11)

    Elawoman can provide a detailed cost estimate based on your particular fertility goals and challenges. You can learn more about cost on our Elawoman site. If you'd like to find out about IUI being an option for you, call Elawoman at +918929020600 for a consultation or schedule an appointment.

    Dr. R K Sharma

    Written by

    MD, MBBS
    Reproductive Endocrinologist, Hysteroscopic Surgeon
    Delhi

    Dr. R K Sharma is ranked among the best infertility specialist and gynecologists in Delhi. He has treated hundreds of infertile patients and has helped many couples achieve their dream of parenthood. He specializes in Embryo Transfer (ET), Intrauterine insemination (IUI), In Vitro Fertilisation(VF) and Hysteroscopic surgery. He is dedicated to his work and gives his best to achieve success. He is well-versed with the latest technological advancement in medicine. He completed his MBBS from the University of Pune in 1981 and continued to pursue MD in Obstetrics & Gynaecology. He was brilliant in his academics which earned him Membership of Federation of Obstetric and Gynaecological Societies of India (FOGSI). He also provides counseling services to couples who are going for IVF for the first time. He performs the treatments with precision and care to improve the chances of success in the first try. Dr. R K Sharma is the founder and director of ART Centre at Army Hospital (R & R) Delhi and Southern Star ART Centre at Command Hospital (SC), Pune. He is presently practicing at Primus Super Specialty Hospital, Chanakyapuri, Delhi.

    Primus Super Specialty Hospital is a reliable and affordable multispeciality hospital in Delhi. They are serving patients in different specialties like sports physiotherapy, Diagnostic Laboratory, Intrauterine Insemination (IUI), Intra Cytoplasmic Sperm Injection (ICSI), Electrocardiogram (ECG), X-ray, In-Vitro Fertilization (IVF), Blood Test, pregnancy care and women wellness. The hospital follows modern methods of treatment to ensure the utmost comfort and care.

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    5 Comments

    user_img

    Sumrit Shahi

    The cost of IUI is very less as compared with other infertility treatments. However, it can vary depending upon the doctor, location and success rate.

    Nov. 13, 2018, 10:45 a.m. 4.5

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    Raman Raj

    I was searching about the cost for IUI as I am advised to get IUI. This article is very good for me. I will go through it and show it to my wife also to get a complete idea.

    Oct. 31, 2018, 12:15 a.m. 4.5

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    Gayatri Sharma

    I had fallopian tube blockage, so on my doctor's prescription, I chose IUI. IUI came out to be successful in the first attempt in my case. Hope everyone who is facing infertility issues gets treated well because now I know that it really feels worst when you are not able to get the happiness of bec…

    Sept. 22, 2018, 6 p.m. 4.5

    user_img

    Deepti Chopra

    It depends on the doctor and city. I mean the location and the success rate of the center providing such treatment. You can check with the website itself. I guess it must be having all the info regarding this.

    Nov. 2, 2017, 3:34 p.m. 4.5

    user_img

    Vachan Subbaratnam

    Can you please also write an article on IVF cost in India?

    Aug. 17, 2017, 7:45 p.m. 4.5

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    The information displayed on this webpage covers general information on several medical conditions, fertility treatments, IVF ICSI, surrogacy procedure, home remedies, and their respective treatments. The exclusive purpose of the displayed information is for the sake of general understanding and it has been collected from open sources which heavily rely on research and laboratory tests. However, the information shared here should not be considered as a medical advice or an alternative to consultation with a registered medical practitioner or licensed healthcare professional.

    It is not advised to self-diagnose or treat any medical condition or disease following the information given in this article. We insist you to consult a registered practitioner and never try to replace their advice or discontinue treatment in between by relying solely on the information obtained. External links to different websites as well as videos given on the website serve the purpose of sharing knowledge only. Ela being an Independent Medical Information platform is neither responsible nor guarantees the authenticity, reliability, and accuracy of these videos and websites in any way. We do not intend the information displayed here to be used for a medical emergency, if you seek medical attention for yourself (or any other person with whom you want to share the information with), we advise you to directly get in touch with the hospital or the doctor.

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