Risk factor / Side effect of Intrauterine Insemination : IUI

Intrauterine Insemination (IUI) is placing the prepared sperm directly into uterine cavity , which  directly increase success rate of pregnancy.  Indication of Intrauterine Insemination has increased manifold with increase in the incidence of infertility.  Therefore to know about the  risk factor/ side effect of   IUI  (Intrauterine Insemination)  is equally being  important .

Intrauterine Insemination is an old and primary  treatment to manage  infertility. The basic aim of Intrauterine Insemination is to increase the number of active & efficient sperm  to reach the Fallopian tube.  Subsequently increase the chance of fertilization.  Initially Intrauterine Insemination was used to treat male infertility  e.g. –  azoospermia, oligozoospermia, asthenozoospermia or  asthenoteratozoospermia. But now  Intrauterine Insemination is also preferred indication  for other indication like un-explained infertility , cervical factors etc.

Intrauterine Insemination (IUI) is of two type.  When  Intrauterine Insemination is performed with male partner / husband sperm, it is called IUI-H.  When Intrauterine Insemination is performed with third party donor sperm, it is called IUI-D.

The objective of this discussion  is to highlight the risk factor and side effect of Intrauterine Insemination as well as  measures to make IUI safe.

Risk factor  of  Intrauterine Insemination

  1. Risk of infection

This is true that risk of infection following IUI is rare.  But this is the time to think about hazard of infection following IUI. There are many factors which increase the probability  of  infection following IUI.

  •  Increasing number of IUI due to increasing rate of infertility.
  • Transmission of infection with sperm.
  • Transmission of infection from human serum albumin used for sperm preservation & sperm processing.
  • Additional risk of unidentified & emerging viruses.

Infertility of all type are  increasing worldwide.  IUI is a basic & primary treatment to treat infertility. Therefore its use is increasing rapidly.  IUI can be performed even with minimum infrastructure and minimal training.  Therefore IUI  is first line as well as applicable treatment  in remote and underdeveloped area.   Where proper method of investigation  may not be available.

Transmission of infection form sperm has been discussed a lot.  Most of medical professional and persons related to Intrauterine Insemination  are aware  about diseases  transmitted by sperm.  It is also relatively easy to  diagnose the  disease transmitted by sperm.  Moreover the male partner/ husband or third party sperm donor  remain in contact with clinician or sperm bank. Therefore they can be tracked or re-investigated even later on or whenever required. Also all sperm banks are releasing preserved sperm after proper quarantine.  Which eliminate  the  chance of disease transmission by sperm.

Transmission of infection from human serum albumin used for sperm preservation is next possibility.  Clinician or sperm  bank don’t have any  access to albumin donor.  Even it is difficult to re-investigate the albumin donors  because it is being pulled from a vast number  people and mixed.    Storage  & transportation of human serum albumin is another issue, which can be compromised anytime because of poor infrastructure in developing or underdeveloped country.

Human serum albumin is processed and treated  to make it safe. But no one can deny about human or mechanical failure.  There are reports that batches of human serum albumin has been taken back from the market.  But no correct data has been published regarding person infected by the use of those Human serum albumin or its product.

Unidentified & emerging viruses is a major future threat  due to use of any human or animal product. Human serum albumin is a known source  of  disease transmission,  presently which is an integral part of  all culture  media used to prepare or preserve the sperm.    Zoonotic disorder are also coming in same grade.  The most favorable and probable route for  transmission of  Unidentified & emerging viruses   is human fluid or human organ transplant. Human serum albumin is one of them.  World need to understand the threat of unidentified & emerging viruses.  It can endanger a big majority of people even before its recognition  or  finding out  preventive measure or treatment.

      2.   Risk  of  Multiple.

The  risk of getting pregnant with twin or more children after  Intrauterine Insemination is not very common but not rare also.  Getting pregnant with multiple is a known side effect of  fertility  medicine taken  during Intrauterine Insemination procedure.   Multiple have certain risk like :

                 Miscarriage                                 Premature delivery                         Low birth weight

                 Gestational diabetes                 Pre-eclampsia                                   etc.

Side effect of Intrauterine  Infection

  1. Fertility medicine taken during IUI.

All medication & medical procedure have some side effect.   To increase the success rate of IUI doctors  prescribe  fertility medicine.  The fertility  medicine  hyper-stimulate  ovary  to release multiple eggs.  Most of the side effect of  Intrauterine Insemination arise due to fertility drugs rather that procedure itself.  The side effects due to fertility drugs are usually mild and  vanishes after discontinuation of  medicine.  Some of the side effects are :

             Mild cramps                       Spotting                               Flashes                                 Headache

             Nausea                                Mood swing                        Depression                           Bloating

              Ovarian cyst                       Pelvic discomfort             OHSS                                     etc.

The process of Intrauterine insemination  may  work as  a trigger factor to the side effect of fertility medicine particularly  Mild cramp &  Spotting.

Discussion  —-    How to minimize  side effect of a medicine  is beyond the scope of  our discussion.  But to make IUI safe  all measures should be taken.  Therefore  in this presentation we will focus  to reduce the risk of infection  and  multiple.  All sperm donor must be screened thoroughly and  rechecked properly before  using their  sperm.  Human serum albumin should not be used for sperm preparation  of sperm preservation.  Risk of multiple can be reduced by judicious use of  ovarian hyper stimulation.

Conclusion —  All  Intrauterine Insemination  should be performed  with H.S.A.  free media or 100 % chemically defined media.  In this way we can prevent transmission of infection by human serum albumin.  The  culture media for intrauterine Insemination require  up-gradation  to make it completely safe.

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