Injecting the fertilized eggs with a culture to treat infertility.

Several causes of infertility can be treated with intrauterine insemination (IUI), which involves injecting sperm into the uterine cavity. IUI is a fertility treatment method that closely resembles natural conception. The basic principle is to inject specially prepared sperm into the uterine cavity at the time of ovulation.

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IUI can be performed in cases where there are difficulties in conceiving due to various reasons, such as:

• Women who have trouble with regular ovulation.
• Men with mild sperm abnormalities.

IUI is also suitable for couples who have timing issues or are unable to have sexual intercourse. Additionally, it is a recommended option for couples with unexplained infertility, where the cause of infertility cannot be identified. Studies have found that in couples with Unexplained infertility , where the woman is over 35 years old and has been trying to conceive for at least two years, with normal sperm parameters in the male partner, the chances of pregnancy through IUI are approximately 8-12% per cycle. Typically, pregnancies occur within the first three IUI cycles, and the chances decrease significantly after the fourth cycle. However, when these couples undergo in vitro fertilization (IVF), the chance of pregnancy increases to over 50% per embryo transfer.

Limitations of IUI include:

• IUI is not suitable for cases of infertility caused by women over 40 years old, diminished ovarian reserve, or lack of regular menstrual cycles.
• It is not recommended for cases with blocked fallopian tubes or severely damaged fallopian tubes due to extensive adhesions.
• IUI is not suitable when the sperm quality is severely compromised, such as low sperm count or poor motility.
• It is not recommended for cases with extensive endometriosis affecting the entire pelvic cavity and causing severe adhesions.

Factors contributing to the success of IUI:

Several factors contribute to the success of IUI, including:

• The woman’s age, with younger age having a higher chance of pregnancy.
• The number of spermatozoa used during the procedure, with a higher number of spermatozoa (more than 5 million) increasing the chances of pregnancy.
• The type of ovulation induction medication, with certain medications having better results than others.

Treatment Process for Intrauterine Insemination

The medical treatment process for intrauterine insemination (IUI) begins with egg stimulation. The patient is given medication to stimulate egg production, starting on the second or third day of their menstrual cycle (counting from the first day of menstruation). This medication is taken for a period of 5 days. After that, on the twelfth day of the menstrual cycle, the patient undergoes an ultrasound examination to determine the size of the mature eggs and their readiness for insemination. This information helps plan the timing of the egg release and the injection of the sperm into the uterus. The medication for inducing egg release is administered 36-40 hours before the insemination procedure.

The medication for egg stimulation is usually started on the second or third day of the menstrual cycle and is administered continuously for 8-10 days. During this period, hormone levels are monitored, and ultrasound examinations are performed to track the growth of the eggs. When the largest egg reaches a size of approximately 2 cm, medication is administered to induce ovulation, and within the next 36 hours, the insemination procedure takes place.

The insemination procedure is similar to a regular internal examination and does not require hospitalization. After the procedure, the patient can go home. On the day of the insemination, the male partner collects the sperm at the hospital using a self-collection method and preserves it in a container specifically designed for sperm collection.

The collected sperm undergoes a separation process to obtain a concentrated sample of live and fast-moving sperm, which is then injected into the uterus using a small catheter.

Video demonstrating the technique of intrauterine insemination.

How many times should the insemination be performed, and when should the treatment method be changed?

Answer: Ideally, the insemination procedure should not be performed more than 3 times. After the third attempt, if pregnancy has not occurred, it is recommended to consider alternative treatment methods. However, for women over the age of 35, it is advisable to limit the number of inseminations to a maximum of 2, as women above this age have a lower natural pregnancy rate due to a decrease in the quality of eggs. If pregnancy has not been achieved after two attempts, it is more appropriate to explore other treatment options that may yield better results, such as in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI).

How many sperm cells are sufficient for pregnancy?

Answer: The recommended quantity of sperm cells for successful fertilization should be at least 5 million cells per injection. Therefore, in cases where the cause of infertility is on the male side, after the separation of sperm cells, if the number of sperm cells is less than 5 million, the chances of pregnancy are very low. In such cases, it is advisable to plan for external fertilization using the ICSI method in the future.

Is it necessary to inject sperm cells once or twice to maximize the chances of pregnancy?

Answer: Injecting sperm cells once or twice does not make a significant difference in the pregnancy rate. The key factor is accurately determining the day of ovulation. If the day of ovulation is correctly determined, a single injection of sperm cells is sufficient. Therefore, accurate determination of the day of ovulation depends on the use of ovulation-stimulating medication and medications to prevent premature ovulation. Additionally, blood tests or urine tests related to ovulation can contribute to more accurate determination of the day of ovulation.

What are the reasons for not achieving pregnancy through sperm injection?

Answer: There are several reasons for not achieving pregnancy through sperm injection into the uterine cavity. For example, poor quality eggs, poor quality sperm cells, an excessively low quantity of sperm cells, or abnormalities in sperm cells that prevent natural fertilization. There may also be obstacles hindering the process of ovulation, such as blockages between the egg and the entrance of the fallopian tube or within the fallopian tube, or the physical structure of the fallopian tube and the egg sac may not be suitable, preventing the egg from entering the fallopian tube.

Recommendations after injecting sperm cells into the uterine cavity:

• Injecting sperm cells into the uterine cavity is a treatment method that closely resembles natural conception. Therefore, post-treatment practices do not differ significantly from natural 
• Conception. There are no restrictions on daily activities, and normal physical exercise or sexual intercourse is allowed.
• After sperm injection, some individuals may experience mild abdominal discomfort due to the presence of released eggs during that period. This discomfort is a result of injecting sperm cells into the uterine cavity, which stimulates contractions of the uterine muscles.
• After sperm injection, some individuals may not experience any abnormal symptoms, while others may experience slight bleeding or spotting, or notice breast tenderness.
• Some individuals may receive hormone supplements through the birth canal to enhance hormone levels during the ovulation stimulation process. In cases where only oral medications are used, there is no need for birth canal supplements.
• Approximately 12-14 days after injecting sperm cells into the uterine cavity, pregnancy can be detected.

Additional recommendations regarding sperm injection into the uterine cavity:

• The chance of pregnancy through sperm injection is approximately 10-20%
  
• Sperm injection into the uterine cavity is a semi-natural method, so the pregnancy success rate is not very high. When this method is not successful, it can be repeated 2-3 times, depending on the age of the female partner. In cases where the female partner is over 35 years old, sperm injection should not exceed 2 times.
• In cases where pregnancy is not achieved through sperm injection into the uterine cavity, the next step is external fertilization, also known as in vitro fertilization (IVF). This method has a higher chance of pregnancy compared to sperm injection into the uterine cavity, around 3-4 times or more than 50% in cases where the age is younger than 35 years old.

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