However hectic life can be, surely couples still have time to make babies? Wrong. Actually, they don’t. It may be because they are living apart due to jobs in different cities. Or they work shifts that don’t give them enough time together. Or they are so stressed out that conception becomes another target that can’t be met.
Such couples are going in for a form of assisted conception that is called intra-uterine insemination (IUI). Ask Dr Shamma Bedi, infertility specialist at Max Hospital, New Delhi. In her career as a gynaecologist and obstetrician, she now comes across a number of such cases. She seems the right person to tell us exactly how this form of insemination is done. “During IUI, washed and prepared sperm is placed in the patient’s uterus (womb).This procedure is often combined with fertility drugs to increase chances of conceiving. IUI is recommended if there is borderline low sperm count or low motility. In many cases, couples are unable to have sex because of disability, injury, or if the spouse experiences premature ejaculation.”
So who, ideally, is a potential patient? She says it’s very important for fallopian tubes to be open and healthy. In many cases, the specialist takes the help of tubal potency tests or X-rays to identify which fallopian tubes are blocked and which are open. “If any of the fallopian tubes is working and ovary is on the same side, then in that case also IUI can do wonders,” Bedi adds. Dr Shivani Sachdev Gaur of sci healthcare says that IUI treatment is one of the most common art procedures in India. “Approximately 5 lakh IUI procedures are done in India. It is a relatively simple procedure so it can be done by all gynaecologists, not necessarily trained IVF specialists.”
She cites an example. Aditi Pandit (name changed) was suffering from polycystic ovaries. She was not ovulating due to hormonal imbalance and excess androgen or male hormone. Her husband had mildly reduced spermatogenesis count (normal spermatogenesis count is around 15 million per ml). His count was 12 million per ml. His sperm mobility and morphology were normal. Aditi was given tablets and injections to induce ovulation and at ovulation her husband sperm was prepared with a special medium and insemination. Two weeks later, she was pregnant.
In many cases, couples don’t require IUI for medical reasons — it is more a question of irreconcilable lifestyles that push fertile young couples to clinics. Here they undergo assisted reproductive technologies (ART). If the husband is planning to go abroad for months, the challenge lies in getting the wife pregnant within the first couple of months of his leaving. If she doesn’t conceive during that cycle, then the attempt has to be repeated when he returns.
Intra–uterine insemination (IUI) is less costly than in-vitro fertilisation (IVF). IVF is the process of fertilisation that involves manually combining egg and sperm in laboratory dish, and then transferring the embryo to the uterus.
In IVF, egg and sperm are fertilised outside the body and then the embryo transferred to the uterus.
According to Dr Ragini Aggarwal, Clinical Director of W-Hospital “IUI is very cost-effective in comparison to IVF. Usually, it takes 3-6 cycles for a woman to conceive. After six failed cycles, she has to think in terms of other types of fertility treatment. IUI is the first-line treatment in selected cases .It’s less invasive and less expensive.” She recalls the case of a couple from Rajasthan where the husband was in the army. The treatment helps them start a family.
While most doctors don’t recommend art for fertile couples, sometimes there is no choice. Dr Bedi, for instance, says that when a couple comes to her for art, and she finds their fertility test results are normal, she advises them to try and conceive the natural way.
Easier said than done. Research done in the US has shown that stress may cause infertility among women. In India, one in seven couple has fertility problem for which there is no medical explanation.