M could not control her emotions. She gave me a big hug. With tears rolling down her cheeks, she exclaimed, “Doc, thank you for presenting me with such a wonderful gift.” This was the first time she was pregnant after a first attempt on intrauterine insemination, an assisted reproductive technique.
M ,a 38 year-old lawyer had been married for 8 years and trying to conceive naturally but unsuccessfully for the past 7 years. She had a mild degree of endometriosis, a condition where there is a back flow of menstrual blood in the pelvic cavity. The endometriosis was treated with laparoscopic surgery, in which a telescope is introduced into the abdomen. She had medications subsequently for 3 months. Her husband’s sperm count was normal except for a slight decrease in the sperm motility.After numerous failed attempts with fertility drug treatment and timed sexual intercourse at the ovulation period, the couple decided on the regime of superovulation and intrauterine Insemination (SO-IUI)
What Is SO-IUI?
It is an assisted reproductive technique in which two to three ovarian follicles (watery sacs in the ovary containing the eggs) are stimulated and brought to maturation and ovulation. A sample of prepared sperm is then placed directly into the uterus for the sperm to swim up the fallopian tube and fertilize the egg.
This procedure will enhance conception for couples with mild endometriosis and mild sperm problem as in M’s case. It is also suitable for the patient whose cervix (neck of the womb) does not secrete good mucus during ovulation. The patient must have normal and patent fallopian tubes
Fertility drugs are usually given for 10 days or more to produce between two to three mature follicles. These drugs(gonadotrophins) are given as injections alone or in combination with oral fertility drug such as Clomiphene. Ultrasound scans are done at intervals to determine the number and size of the follicles before another injection (HCG) is given for final maturation and subsequent ovulation of these follicles.
On the day of the insemination, the semenis prepared in the laboratory and the motile fraction harvested and placed into the uterus using a fine catheter through the cervix.
Occasionally, the procedure may be discontinued because of poor response or over response of the ovary.
Whilst M was jubilant with the pregnancy, I warned her about the risks of miscarriages, foetal abnormalities and premature birth which are increased in older mother.
She is now in her second trimester and the pregnancy is normal so far. The couple feel reassured every time I show them the baby moving inside the womb using the ultrasound machine.