From the evolutionary point of view, the impetus for procreation is deeply imbedded in our DNA that it will seek expression in a variety of ways. But in some couples, this natural desire is impeded by faulty human anatomy or failure of the regulating glands to produce reproductive hormones.
There are of course ways to get around unwanted childlessness. Medical professionals call it ART or assisted reproductive technology.
For intrepid couples who want to circumvent their natural impediments, there are several options they can explore. Intrauterine insemination (IUI) is the first step in that ladder.
In the past when ART was not easily accessible to couples because the technology did not yet arise, alternative therapies, like fertility enhancement herbs, acupuncture and fertility massage, were usually recommended to infertile couples. Now, childless couples can benefit from IUI, although the rate of success varies from case to case and highly dependent on a multitude of factors.
Intrauterine insemination is the most ‘natural’ of all ARTs. It is highly recommended for couples who may suffer from any one or a combination of the following.
The female spouse has irregular or absent menses. Unpredictability of menses leads to ovulation problems.
The female spouse has acidic cervical canal. Sperm can survive up to 5 days in a conducive environment.
The female spouse has obstructed Fallopian tubes. Even though she has healthy ovaries producing healthy eggs, if her ‘tubes’ are blocked, she will have difficulty conceiving. One unobstructed tube is sufficient for IUI to be performed.
The male spouse has erectile dysfunction or impotence problems. ED problems can range from retrograde ejaculation (sperm flow back up into the bladder instead of its natural pathway) or premature ejaculation (ejaculate is not deposited into the uterine cavity).
The male spouse has issues with sperm count or motility. Hundreds of millions of sperm are released in a healthy ejaculation, but the sperm count in male with ED or similar problems is significantly lower (only tens of millions).
Either one of the spouse has medical issues aside from infertility.
Both spouses have unexplained infertility despite being physically healthy.
In IUI, these problems are directly addressed or bypassed altogether. For example, if the wife has problems ovulating, she could be prescribed with fertility medicines like clomid. If the husband has low sperm motility, his specimen is ‘washed’ so only the most mobile sperm are introduced into the womb. ‘Washing’ entails putting the sperm in a medium and letting them swim up to a certain layer. The sperm that makes it in that stratum are removed and introduced into the uterine cavity.
The actual IUI procedure is not invasive relative to other ART techniques. Insemination with a syringe is simply a substitute of how conception is naturally done. The insemination is performed to bypass the acidic cervical environment and to introduce the sperm to the embryo as close as possible. In other words, IUI is simply a clinical way to do it.
So what should couples expect during the actual IUI procedure?
For the male, he is asked to produce a sample on the day of the actual insemination. This specimen is then washed and set aside for the actual insemination later.
For the female, she may have to choose between non-medicated or medicated cycle. In the former, it is usually the male spouse who has fertility issues; in the latter, it is her reproductive cycles that impede the natural conception process.
For medicated cycles, she will be given clomid or metformin to be taken for five days, after which her follicles are measured for maturity. Once the follicles are mature, the sperm are introduced within 36 hours to coincide with the ovary’s release of the eggs.
She may then leave the clinic afterwards, with instruction to follow up with ‘natural’ insemination within the day.
The success rate of IUI is highly dependent on the woman’s age (the older the woman the lower the rate of success), on her health, and on the severity of her infertility problem. To a significant extent, the success rate is also influenced by the male’s sperm performance.
Couples may have to undergo up to six IUI cycles to achieve results. On healthy couples, there is 15% chance of conception on every cycle performed. This means that on the sixth cycle, couples can expect to achieve up to 90% success rate.
Should the IUI cycle remain unproductive, couples may discuss with their reproductive endocrinologists other forms of intervention. In vitro fertilization (IVF) is one such alternative.