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IUI is a procedure in which sperm are washed, concentrated, & deposited directly into a woman's uterus. The circumstances to choose IUI are the same as described but specifically if Cervical mucus is a problem resulting in cervical hostility. It is also carried out in ovulation disorders and unexplained infertility in conjunction with COH. Women with endometriosis may benefit from it if they do not have a distortion of the pelvic structures. IUI is most successful when it is coupled with controlled ovarian hyperstimulation (COH).

Male partner requirements: IUI relies on the natural ability of sperm to fertilize an egg within the reproductive tract. IUI will not be effective in cases where the male has extremely low sperm counts or poor sperm shape. Sperm tests should show reasonable sperm function, at least 5 millions sperms in swim up.

Female partner requirements The wife should have no fertility problems. Tests should show normal ovulation. Women with ovulatory disorders can be candidates for IUI if they respond adequately to fertility drugs to stimulate ovulation. Open fallopian tubes. Women with severely damaged or blocked oviducts will not be helped by IUI and a normal uterine cavity. The IUI is timed to take place around the ovulation time. 

The Procedure Sperms used in IUI must first be properly prepared by the process known as sperm washing; a process that takes more than an hour. For IUI a minimum of 5 million sperms with forward progressive motility in swim up are required. The woman after slipping down her trousers lies down with her legs drawn up and knees apart. A speculum is inserted into the vagina which is opened to expose the cervix.

A thin plastic catheter is inserted into cervix. It is pushed onwards beyond the cervix so that t he tip of the catheter is in the uterus near the tubal openings. It usually passes easily. In case of difficulty the cervix is caught and pulled a little to correct the angle of flexion. It makes the entrance easy. Rarely if cervix is stenosed, a uterine sound may need to be passed to open it.

The syringe filled with the sperm is attached to the end of the catheter and the sperm sample is pushed out of the syringe under light pressure. It travels through the catheter to the uterus.

In natural intercourse only a fraction of the sperms make up the woman’s genital tract. IUI increases the number of sperm in the fallopian tubes (place of fertilization) by shortening the passage. Only the good spermatozoa reach there with their much-required energy conserved for the penetration of the ovum. They approach the ova without consuming their energy; therefore even weaker sperm may be able to fertilize the ovum. For many couples, this is less invasive and more affordable than IVF. It can be an alternative to IVF only if woman’s reproductive organs are healthy and the oviducts are open and functional.

Most women consider IUI to be fairly painless. There can be some cramping afterward, but what is felt is ovulation-related rather than from the IUI. The catheter often isn't felt because the cervix is already slightly open for ovulation.

Complications of IUI are infrequent. They can include infection, and brief uterine cramping. 

Success rate in IUI is 10-15%. IUI helps in most of the cases if there is no biological barrier. If the woman is not pregnant after three IUI attempts, the next step is usually IVF-ET.

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