IUI: The Treatment Option of Choice1

The history of IUI dates back to 1770 when John Hunter advised a man to inseminate his wife with his semen collected in a warm syringe. The indication was that of hypospadias. This resulted in pregnancy. In 19th century, Marion Sims carried out inseminations in 6 women. He got success in only one woman. In 1953, Bunge and Sherman reported the first pregnancy from stored frozen semen.

IUI was not practiced till recently due to the fact that direct insemination into the uterus without a wash (Preparation of Sperms) causes severe uterine cramps due to the presence of prostaglandins. The advent of in vitro fertilization and embryo transfer (IVF-ET) and other assisted reproductive techniques which utilize the sperm wash techniques with ovarian stimulation have led to the practice of IUI.

When considering fertility treatments above and beyond fertility drug use, IUI may be the first tried. It's easier to do than assisted reproductive technologies, like IVF, and costs much less. It is a painless, precise, simple, easy and atraumatic technique. A bolus of concentrated, motile, morphologically normal and capacitated sperms are deposited in the uterine cavity very near to the opening of the ostia of fallopian tubes at the time of ovulation.

In the 1980s, direct intraperitoneal insemination (DIPI) was occasionally used, where clinicians injected sperm into the lower abdomen through a surgical hole or incision, with the intention of letting the sperms find the oocyte at the ovary or after entering the genital tract through the ostium of the fallopian tube.

The selection of patients for IUI has to be very appropriate. In the male, there should be at least 10 million motile sperms and in the females, the age should be less than 40 years and at least one fallopian tube must be patent. Endometrium should be normal and the ovaries should be capable of ovulating. It is also mandatory that the sperms should be able to fertilize the oocyte. The ability of the sperm to fertilize cannot be known by IUI. The only method by which the fertilizing capacity of sperms can be known is IVF-ET. This is how IVF-ET 2has an edge over IUI. IUI is only a treatment modality whereas IVF-ET has both therapeutic and diagnostic value.

In unexplained infertility, the sperm may be inserted within a larger volume of fluid than usual so as to reach up into the fallopian tubes more easily. This technique takes a few minutes more than standard IUI and is known as “fallopian sperm perfusion”. It has been shown to increase the chances of success in cases of unexplained fertility.

The advent of Medically Assisted Reproductive Techniques (MART) has not only gifted the world with new creation of life but also with newer techniques for reproduction. IVF-ET has given birth to IUI. The necessity of having sperm wash techniques for IVF resulted in clinician's using this modality as a treatment. Though the advent of artificial insemination is very old and dates back to the 18th century, the first ever-published article on IUI is only during the 20th century.

Initially, IUI was thought to benefit patients with only cervical infertility or hostility. In the present scenario, cases of unexplained infertility, immunological infertility and endometriosis also benefits from this treatment modality.