Introduction :— IUI is a very old as well as established method to treat infertility. The aim of this presentation ‘Past , Present & Future of IUI’ is to make people aware about future of IUI. In future what should be the aim and how it can be targeted will be emphasized. Past, present & future of IUI is having a history of two century. Certainly future of IUI will be unlimited. Technology of IUI has improved a lot but still there is a long distance to travel to get more success in IUI.
Overuse of IVF / ICSI is another aspect. Our discussion ’Past , Present & Future of IUI’ will not focus on any aspect of other modality of infertility management. Our aim will be to discuss the measures or changes required to improve productivity of IUI. Which will ,hopefully, improve the success rate and efficacy of IUI in future.
IUI — Intra uterine Insemination, IVF — In vitro fertilisation, ICSI — Intracytoplasmic sperm injection, ET – Embryo transfer.
Past of IUI :–
According to available data first IUI reported in 18th century by an Scottish surgeon John Hunter. He performed and effective procedure by using husband sperm.
1884, was the year, first time a live birth is in record by using donor sperm by William Pankhurst from Philadelphia.
In second half of 20th century IUI used in cattle & pigs as very preferred method to maintain pedigree & improve yield.
Direct Intra-Peritoneal Insemination (DIP) was tried in 1980s. It was concluded in multiple study that direct intra-peritoneal insemination (DIP) does not offer better pregnancy rate than IUI.
Present of IUI :–
In present scenario IUI is a common & popular procedure among all ART (assisted reproductive technologies, i.e. – IVF-ET, ICSI) procedure.
The popularity of IUI is because of —
Simple to perform
Cost effective / Expensive infrastructure not required
Non invasive technique
IUI is possible even with limited resource.
Very low risk for complication
Less stressful for patient & staff
IUI with ovarian stimulation is in many countries first-line fertility treatment for couples with unexplained and mild male infertility.
One obvious indication for IUI is use of donor semen. When donor semen is used in IUI, it is called IUI-D. IUI-D is performed with following indication –
No sperm in semen (Azoospermia)
Abnormal sperm (asthenozoospermia or asthenoteratozoospermia)
When man is carrier of genetic mutation
In case of inherited disorder. e.g. – Huntington’s disease or hemophilia
High risk of disease transmission, e.g. – HIV, Hepatitis, etc.
Severe Rhesus incompatibility of the mother
Single women , who want to have a baby
Female Homosexual couple, willing to have a baby
There are also known indication for IUI with husband When husband sperm is used for IUI, it is called IUI-H. IUI-H is indicated in following condition –
IVF is not affordable due to financial barrier.
Sexual disorder. e.g. — erectile dysfunction, ejaculatory failure, vaginismus, hypospadius, etc.
Cervical factor infertility
Cervical scar due to some prior operation of cervix, not allowing the sperm to cross cervix.
Early stage of endometriosis
Psycho-sexual problem, where intercourse is not possible.
When patient need special method of treatment, (e.g – sperm washing in case of HIV infected male partner).
Future of IUI :–
In Future the IUI must be upgraded with the aim to —-
Get maximum success rate.
Minimum complication rate.
Incorporation of new easy and success oriented method
Maximum success rate — Success rate of any technology depends on frequent positive up-gradation and continuous follow up. Which ultimately prove the superiority or inferiority of new technology. Usually up-gradation is based on past and present experience of particular technology.
The success rate of IUI can be increased by minimizing or replacing the factors which stimulate the uterus to reject the sperm or components of culture media used in IUI.
In usual case sperms are not treated as foreign body by uterine cavity. But in some case anti sperm antibody can be detected. Even the level of anti sperm antibody can be high enough to cause infertility.
Proteins / component of serum from other individual is capable of stimulating an immune response to produce antibody.
Reducing the antigenic activity of sperm and replacing the serum component of other individual by non antigenic salt appear an effective measure to improve future of IUI.
Minimum Complication rate :- Complication , like infection, disease transmission, particularly transmission of unidentified & emerging viruses can be abolished by not using human, animal or avian protein or blood product.
Incorporation of new method :- Introduction of Intra Uterine Tubo-Peritoneal Insemination (IUTPI) is a promising approach. Where washed sperm is flushed in uterine cavity & fallopian tube. Followed by clamping of cervix to prevent leakage of sperm to the vagina. In future this may be a preferred method of IUI.
Discussion – One obvious measure is to replace the use of H.S.A. (Human Serum Albumin) or any complex protein for IUI. H.S.A. is a potential source to transmit many infections. Moreover H.S.A. is a complex molecule. Its function is still not very clear. Certainly it improve the motility of sperm but because of its unknown & doubtful structure, it may affect the end result adversely also. Replacement of H.S.A. or any human, animal or avian protein by some defined molecule is a proper way. New technology should be always under trial.
Conclusion – To sum up, the intrauterine insemination is cost effective and efficacious procedure to treat infertility. Reduction in antigenic activity of sperm is a good approach. If we think about Future of IUI. Replacement of H.S.A. by more simple and chemically defined substance is a demand for future of IUI. New method should be always under trial.