IUI in Singapore: Process and chances of pregnancy
Background
In 2020, Singapore’s total fertility rate (TFR) fell to a historic low of 1.1[1]. This was mainly brought by the pandemic stress, delayed parenthood plans and decrease in marriages.
These factors aside, there are many in Singapore who aspire to be parents but suffer in silence due to their inability to conceive. Infertility is highly stressful, and can affect the relationship of the couple.
If you and your partner have tried many times to conceive without good news, then it may be time for you to look at more advanced methods. Of the fertility treatments in Singapore, IVF tends to come to mind first for many couples – but what many don’t know is that IVF usually comes after other reproductive techniques, such as IUI, have failed.
In this article, we’ll discuss IUI, a fertility treatment often done before IVF.
What is IUI?
Intrauterine insemination (IUI) is a treatment for infertility that is done through artificial insemination.
The natural way for a woman to conceive is for sperm to reach the ovary from the vagina, passing through the cervix, uterus, and fallopian tubes. However, there are instances when the sperm are not able to complete this long process. Through intrauterine insemination (IUI), the chances of getting pregnant are higher[2]as the “washed” sperm are concentrated and injected into the uterus. This method cuts the distance that the sperm need to travel, which increases their chances of penetrating the egg.
Some patients may be eligible for Superovulation Intrauterine Insemination (SO-IUI). This treatment is a combination of two procedures:
- Superovulation (SO)
- Intrauterine insemination (IUI)
Superovulation is a process that is carried out with the use of hormonal medication to trigger the development and ovulation of two or three ovarian follicles. Once the eggs have matured and ovulated, the sperm is then placed in the uterus.
SO-IUI has an average success rate of 15.9%[2] per treatment cycle.
When is IUI performed?
The best candidates[3] for IUI are couples who have:
- Cervical mucus problems
Overproduction of mucus can become thick and hinder the sperm from reaching the uterus.
- Ejaculation or erectile dysfunction
- Low sperm count or other problems affecting the sperm’s quality
This is identified through semen analysis. The results may show that the count of the sperm is below the needed quantity for conception or the sperm is weak, small, slow, or shaped differently.
- Semen allergy
An adverse reaction to sperm can cause a woman’s vagina to burn and swell.
- Sperm donors
This is done for couples whose male partner has low quality sperm or no sperm at all. The procedure can also be used for women who are single and wish to conceive.
- Unexplained infertility
SO-IUI is recommended for women who have experienced a number of failed clomiphene cycles and couples who have mild conditions of:
- Cervical factor infertility
- Endometriosis
- Male factor infertility or subfertility
- Unexplained infertility
In addition to the above, to qualify for SO-IUI, female patients should also have unobstructed fallopian tubes and males a healthy supply and reasonable amount of sperm.
IUI in Singapore: What is the process like?
Intrauterine insemination involves 4 steps:
| Step 1: Monitoring ovulation | Knowing your ovulation cycle is crucial to inject the sperm with correct timing. Your ovulation is predicted through the presence of luteinizing hormones (LH). Detection of this hormone can be done by using an ovulation prediction kit, blood tests, or a transvaginal ultrasound. Ovulation usually happens within 10 to 16 days following the first day of your menstruation cycle. |
| Step 2: Preparation of semen | During your scheduled IUI procedure, your partner must provide a sample of fresh sperm. The sperm can also be provided beforehand, frozen and then thawed once the time is right to inject it into the uterus. The sperm undergoes a process called “sperm washing” to prepare it for insemination – this ensures only healthy sperm are chosen. |
| Step 3: Insemination | Insemination of the prepared sperm is administered 24 to 36 hours after detection of luteinizing hormones (LH). This is done using a catheter that is inserted into the cervix reaching the uterus. It is advised you lie down for 30 minutes after the insemination. |
| Step 4: Pregnancy test | The results of the insemination can be determined through a pregnancy test taken 14 days after IUI. |
Does IUI guarantee pregnancy?
A study[4] done in 2017 discovered that the success rates of getting pregnant for women with cervical factors is high, following a maximum of three IUI cycles without superovulation. For patients with cervical problems, the highest pregnancy rate is at 36.8% and 38.3% for those unable to conceive due to male infertility. Generally, when used in combination with fertility drugs, the pregnancy rate for IUI is between 15% to 20%.
Read: Is it male infertility or performance anxiety?
The success of conception through IUI can be known 2 weeks after the insemination. You will be asked to do a urine test at home using a pregnancy kit or you may be required to undergo a blood test for a more accurate result.
How can I increase my chances of pregnancy with IUI?
There are various factors that can influence the success of an IUI treatment. These factors include:
- Age
A woman’s fertility significantly drops as she ages because the quality
of eggs produced by her body decreases.
- Cause of infertility
Besides age, poor sperm quality and medical conditions like endometriosis, polycystic ovary syndrome (PCOS) and uterine fibroids can affect fertility. As such, before starting IUI treatment, consider going for a fertility screening in Singapore.
- Timing of treatment
Insemination should be done at the right time as any delay or premature administration can result in unsuccessful conception.
To further increase your chances of getting pregnant through IUI, consider consulting a reputable fertility specialist and making lifestyle changes to increase sperm and egg quality. These include:
- Regular exercise
- Sticking to a healthy diet
- Managing your anxiety and stress
- Quitting or avoiding excessive alcohol drinking and smoking
References
- https://www.channelnewsasia.com/singapore/singapore-total-fertility-rate-tfr-falls-historic-low-2020-baby-376711
- Duran HE, Morshedi M, Kruger T, et al. Intrauterine insemination: a systematic review on determinants of success. 2002. In: Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. York (UK): Centre for Reviews and Dissemination (UK); 1995-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK69036/
- https://my.clevelandclinic.org/health/treatments/22456-iui-intrauterine-insemination
- Allahbadia G. N. (2017). Intrauterine Insemination: Fundamentals Revisited. Journal of obstetrics and gynaecology of India, 67(6), 385–392. https://doi.org/10.1007/s13224-017-1060-x