Intrauterine Insemination in Milan

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First Level MAP: Intrauterine Insemination (IUI)

Level I Medically Assisted Procreation (MAP) includes less invasive and less expensive fertilization techniques than level II and III techniques, such as in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI). Among these, Intrauterine Insemination (IUI) stands out as an initial approach for many couples facing fertility problems. It involves the direct insertion of selected and prepared sperm into the woman’s cervical canal or uterus near the time of ovulation to facilitate fertilization. This technique is recommended in cases of unexplained infertility, mild endometriosis, ovulation problems, or minor male factors such as reduced sperm mobility.

What is it

Intrauterine Insemination (IUI) is a form of Medically Assisted Procreation (MAP) that involves the selection and insertion of sperm directly into a woman’s uterus during her fertile period. This process is intended to increase the chances of sperm and oocyte matching by overcoming any obstacles that might prevent the sperm from reaching the oocyte in the fallopian tube. Unlike more complex and invasive fertilization techniques, IUI maintains the natural fertilization process within the female body, often representing the first step in the PMA journey for many couples. The procedure relies on the use of sperm previously collected and processed in the laboratory to improve their quality and mobility, thus increasing the likelihood of success.

Why do intrauterine insemination?

The choice to use Intrauterine Insemination (IUI) is often motivated by a deep desire to overcome obstacles to natural conception, seeking a solution that is both effective and less invasive than other Medically Assisted Procreation options. This technique represents hope for many couples facing challenges on the path to parenthood, offering an affordable alternative that is considered less physically and emotionally stressful. The main reasons couples opt for IUI include:

  1. Unexplained infertility: In cases where the causes of infertility remain elusive despite thorough examinations, IUI offers itself as a practical first approach, opening the door to possible reproductive success without immediately resorting to more invasive methods.
  2. Ovulation problems: For women facing ovulation-related difficulties, such as irregular cycles or no ovulation, IUI, sometimes combined with ovulation-stimulating drugs, can significantly increase the chances of pregnancy.
  3. Mild male factors: In cases of mild sperm abnormalities, such as reduced motility or concentration, IUI provides sperm with an easier pathway to the oocyte, enhancing the chances of fertilization.
  4. Mild endometriosis: Women with mild forms of endometriosis may find IUI a valuable support to increase the chances of conception.
  5. Use of donor sperm: IUI also represents a fertility option for couples coping with severe male infertility, singles or lesbian couples eager to start parenthood through the use of donor sperm. Currently, this procedure, unfortunately, is not yet legally allowed in Italy.
  6. Through IUI, many couples find a path toward the realization of their desire for parenthood, thanks to an approach that balances effectiveness and respect for the natural processes of conception.

Preparatory stages for intrauterine insemination

Preparation for Intrauterine Insemination (IUI) is critical to increasing the chances of success of the procedure. These preparatory steps include:

  1. Initial evaluation: Prior to IUI, it is essential to undergo a thorough medical evaluation to identify any health problems or factors that could adversely affect the outcome of the procedure. This step includes blood tests, sperm quality tests and, if necessary, evaluation of the condition of the uterus and fallopian tubes.
  2. Ovulation monitoring: Synchronization is crucial in IUI. Patients may need medication to stimulate ovulation, followed by careful monitoring through blood tests and ultrasound scans to determine the optimal time for insemination.
  3. Sperm preparation: Before insemination, the sperm sample is processed in the laboratory to concentrate the most motile and healthy spermatozoa, thus increasing the chances of fertilization. This process, known as “sperm capacitation,” is crucial to the success of IUI.
  4. Scheduling of insemination: Once the optimal time of ovulation has been identified, insemination is precisely scheduled to maximize the chances of success. The procedure must occur within a specific time frame to ensure that sperm are present in the uterus at the time of ovulation.

These preparatory steps are essential to optimize the conditions for the IUI to have the best chance of success, requiring close collaboration between the couple and the medical team.

How it is done

Intrauterine Insemination (IUI) is a procedure that is characterized by its simplicity and minimal invasiveness, playing a key role in the assisted reproductive journey of many couples. The procedure consists of a few key steps, performed with care and precision by the medical team.

First, on the day set for insemination, the sperm sample, already prepared and concentrated in the laboratory through the capacitation process, is loaded into a thin syringe connected to a catheter. This extremely thin and flexible instrument allows it to gently pass through the cervix, minimizing discomfort for the patient.

The woman is positioned on a gynecological couch, in a posture similar to that adopted during a pelvic examination. Using a speculum for easier access to the cervix, the physician introduces the catheter through the cervical canal to the uterus. In this controlled environment, sperm are gently deposited inside the uterus, near the fallopian tube, where the oocyte waits to be fertilized.

The procedure is quick, generally painless or accompanied by mild discomfort, and does not require anesthesia. After insemination, the patient may be asked to lie down for a short period to facilitate the possible encounter between sperm and oocyte.

Despite its apparent simplicity, IUI is the result of precise timing and preparation aimed at maximizing the chances of success. The procedure is based on a thorough understanding of reproductive physiology and careful technique, reflecting the medical team’s commitment to assisting couples on their journey to parenthood.

Success rate

The success rate of Intrauterine Insemination (IUI) varies significantly depending on many factors, including the woman’s age, the underlying cause of infertility, and the quality of sperm used. In general, statistics indicate that the success rate per cycle of IUI is between 10% and 20% for women under 35 years of age, decreasing progressively with increasing age.

The woman’s age is one of the most critical factors: female fertility begins to decline more markedly after the age of 35, directly affecting the likelihood of IUI success. In addition, specific conditions such as low sperm quality or ovulatory problems may require additional approaches to optimize the chances of conception.

For many couples, IUI is the first step on the path to assisted reproduction, being able to be repeated for multiple cycles to increase the overall likelihood of success. The decision on how many cycles of IUI to attempt before considering more invasive treatments, such as IVF (In Vitro Fertilization), depends on medical recommendations, the couple’s specific health conditions, and their emotional and financial situation.

It is important to maintain open communication with one’s physician, who can provide individualized counseling based on medical history and previous treatment results, thus helping to navigate the fertility journey with clear information and support.

Risks and complications

Although IUI is considered a low-risk procedure, there are some potential complications that couples should consider. Among these, the risk of infection is minimal but present, as is the possibility of mild post-procedure bleeding due to the passage of the catheter through the cervix.

One of the specific risks associated with the use of ovulation-stimulating drugs often associated with IUI is ovarian hyperstimulation syndrome (OHSS), which can range from mild to severe and require medical attention. In addition, treatment increases the chances of multiple pregnancies, which carry with them an increased risk of complications for both mother and fetuses.

The choice to proceed with IUI should be made after careful evaluation of the potential benefits and risks, discussing openly with one’s physician to ensure an informed and informed decision.

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