Overview of intra-uterine insemination in a Sri Lankan scenario

Abstract

In-vitro fertilization services are still not available in the government sector in Sri Lanka and there are no indicators of these services being available in the government sector in the near future. Even in the private sector these services are available only in a few centres at a considerable cost. Like in many developing countries in Sri Lanka also the cost of IVF treatment is a major issue. Most of the health insurance policies do not cover expenses involved in subfertility treatment. Proper evaluation of the couple is extremely important before planning treatment. Compared to IVF treatment intra-uterine insemination (IUI) is a much simpler method which is highly cost effective and can be easily popularize in the government sector health institutions. But certainly this is not the first line of treatment as ovulation monitoring and timed intercourse should be tried before initiating IUI therapy in suitable couples. IUI should always be done with washed prepared sperms. Use of neat sperms for IUI can result in painful uterine cramps, collapse, infections and therefore should never be performed. Artificial insemination can be done in several ways i.e. intra-vaginal, intracervical, intrafallopian, intraperitoneal or intrauterine. The rationale for the use of IUI instead, intra-vaginal or intra-cervical insemination is to reduce the effect of factors such as vaginal acidity and cervical mucus hostility. Also there are benefits from deposition of prepared motile morphologically normal sperms as close as possible to the oocytes at the time of ovulation. Ejaculatory failure is a definitive indication for IUI. In cervical mucus hostility IUI bypasses the mucus in the cervical canal. Other indications for IUI are oligospermia, and unexplained infertility.