WHAT IS IMMUNIZATION (IUI)?

Insemination is a simple, low-risk method used in the treatment of infertility. In this method, the sperm are washed and concentrated, and healthier and more active ones are selected. These are then deposited through a catheter into the uterus, close to the eggs, at the time of ovulation. In some cases, insemination can also be applied to the cervix or vagina. However, the success of this type of insemination is lower than that of intrauterine insemination.

How Many Types of Insemination Are There?

During the insemination process, sperm can be deposited in different areas of the female genital system. The common point in all of them is that sperm are released into the female reproductive system, increasing the chance of fertilization. The insemination process is named according to where the sperm are deposited. Some of the most commonly used types of insemination are:

• Intra-vaginal insemination: This is the easiest form of insemination. Prepared sperms are placed into the vagina through a special catheter. This method is mostly used in couples who cannot have sexual intercourse or have vaginismus problems.

• Intra-cervical insemination: In this method, sperm is injected into the cervix.

• Intra-uterine insemination: The sperm prepared here are released into the uterus through a special catheter.

• Intra-uterine tuboperitoneal insemination: In this method, a larger amount of semen is used and first the uterus and then the tubes are filled with sperm.

• Intra-peritoneal insemination: In this method, sperm are passed through the vagina with a small needle, passed into the abdominal cavity and left there.

Who Can Be Vaccinated?

IUI treatment is preferred in women with at least one of their tubes open and in couples who do not have serious reproductive problems. Thus, it is hoped that the sperm placed in the uterus will easily reach the eggs waiting in the tubes to be fertilized and pregnancy will be achieved. Vaccination is generally used as the first option in many reproductive problems. Some of these are as follows:

• Infertility of unknown cause: Vaccination is the first treatment option, generally applied together with egg enhancing drugs, in cases of infertility of unknown cause.

• E Infertility due to endometriosis: In women with endometriosis and/or chocolate cysts, some problems that may occur in ovulation, egg quality, preparation of the uterus for pregnancy and fertilization phase make it difficult to get pregnant. These negativities are tried to be overcome by applying ovulation treatment and vaccination in these patients.

• Mild-moderate male infertility: Some abnormalities are sometimes observed in semen analysis in men. These abnormalities may be low sperm count, low sperm motility, or sperm deformities. If these are mild or moderate, vaccination can be done. While the sperm is being prepared for insemination, the problematic sperm are separated and the healthy and mobile ones are concentrated and taken to be injected into the uterus.

• Infertility due to cervical factor: The cervix is ​​necessary for the passage of sperm from the vagina to the uterus and from there to the tubes where the eggs are located. The secretions of the cervix change around the time of ovulation. During this period, it secretes substances that accelerate the passage of sperm and increase the fertilization ability of sperm. However, in some women, this secretion is thicker and stickier than necessary and does not allow sperm to pass through. In fact, sometimes the substances and antibodies in this secretion can be lethal to sperm and restrict their movement. These types of problems in the secretion of the cervix are generally caused by previous infections and some interventions made on the cervix. Sometimes this can also be structural. In such cases, the cervix is ​​bypassed by insemination and the sperm are released directly into the uterus.

• Semen allergy: Rarely, some women may be allergic to some substances in their partner's semen. These may include burning, itching, redness and swelling in the vagina after intercourse. Condoms are used in the treatment of such situations. However, since the use of condoms prevents pregnancy, vaccination is applied to couples who are considering having a baby. While sperm is being prepared for insemination, most of the substances that cause allergy in the semen are removed.

How is the Insemination Process Done?

Vaccination is generally a short and painless procedure. The vaccination process itself takes a few minutes. The total duration of the process is either It is approximately 15-20 minutes. It is usually performed in the doctor's office or clinic. There may be mild cramping and spotting during and after the procedure. However, after the procedure, normal activities can be resumed immediately or the next day. The stages of the vaccination process can be listed as follows:

• Preparation of the woman: Before starting the vaccination treatment, a detailed examination of the expectant mother is performed to check whether there are any problems in the uterus, ovaries and tubes. . If there is an infection etc., it is treated. Precautions are taken against problems that may occur during pregnancy by performing some blood tests. In patients with habits such as smoking, alcohol etc., these should be stopped. Correct and balanced nutrition is recommended. Start with medications containing folic acid.

• Following egg development: Timing is very important for the success of vaccination. Vaccination is done when the egg is about to hatch. The life span of the egg is 12-24 hours. Vaccination before or after this period will fail as the egg is no longer viable. For this reason, some blood or urine tests are performed to determine the time of ovulation in patients who are planned to be vaccinated in their natural cycle and who do not use egg enhancing drugs. Sometimes mature eggs are cracked using medication and the time of vaccination is adjusted accordingly.

• Use of egg enhancing drugs: To increase the success of vaccination in some patients, sometimes Some egg enhancing drugs are used to develop more eggs in patients who do not ovulate spontaneously or whose ovulation is weak. These may be in the form of injections or pills. In patients using medication, when the eggs mature, they are cracked using a cracking needle. Insemination is usually done 24-36 hours after the insemination injection.

• Semen preparation: Before the insemination, sexual abstinence is performed for 2-5 days. On the day of the vaccination, a few hours before the procedure, the man gives a semen sample in a private room. The semen sample is washed and more mobile, high quality and healthy sperm are selected and placed in a tube. The semen sample is cleared of foreign substances. In this way, a sample with a small volume but high density was obtained. It works.

• Optimal timing: Vaccination is done 1-2 days after the detection of ovulation. When a cracking shot is administered, vaccination is performed 24-36 hours after the injection is administered.

• Inoculation Procedure: The patient is prepared to be examined on the gynecological table. Then, spoons called speculums are placed into the vagina and the cervix is ​​seen. The previously prepared semen sample is drawn into the syringe. It is then passed into the uterus through the vagina and cervix via a thin, long, soft catheter. Then the catheter and speculum are removed. After the patient lies on his back and rests for about 15-20 minutes, he is removed from the table.

• Post-procedure recommendations: After the procedure, patients can immediately return to their normal lives. Some patients may experience mild groin pain and spotting after the procedure. They can rest on the day of the procedure and return to their normal lives, daily activities and sexual lives the next day. A pregnancy test is performed 2 weeks after the vaccination process.

Complications of Vaccination

Vaccination is generally a simple and safe procedure. Therefore, the probability of a serious complication related to the procedure is extremely low. Some complications that may occur due to the procedure are as follows:

• Infection: there is a slight risk of infection due to the insemination process.

• Spotting: catheter uterus While being placed inside, it may sometimes touch the surrounding tissues and cause bleeding in the form of spotting. The presence of spotting does not affect the chance of pregnancy.

• Groin pain: Semen released into the uterus and some of the substances in it can sometimes cause cramp-like groin pain. This may continue for a few days and then go away on its own.

• Multiple pregnancy: If the vaccination process is done using egg enhancing drugs, the possibility of multiple pregnancy, that is, twins, triplets, etc., increases. For this reason, treatment may be canceled in patients who develop more than three eggs during treatment due to the risk of multiple pregnancy.

Success of the Vaccination Process

The pregnancy rate in the vaccination process is 3-5% for each treatment session. But soft If it is done together with RT enhancing drugs, the success increases to 15-20%. Pregnancy rates increase to 60% when vaccinated 3 times in a row. After the third vaccination, success rates begin to decline. For this reason, 3-6 vaccination procedures are generally applied. If pregnancy cannot be achieved in this way, in vitro fertilization is used.

Factors Affecting Success in IUI

There are many factors that affect the success of IUI. The most important of these are as follows:

• Age of the woman: While success is higher in young women younger than 35, success is lower in older women.

• Egg and/or sperm quality: Good egg or sperm quality increases success.

• Severe endometriosis reduces success.

• Damage or abnormality in the tubes reduces success.

• A previous serious infection related to the uterus and tubes reduces success.

• Any abnormality in the uterus (polyp, myoma, double uterus, adhesion, etc.) reduces success.

• Having problems in sperm parameters (number, motility, morphology) reduces success.

Am I Suitable for Vaccination?

• First of all, to decide this You should be examined by a Gynecologist who specializes in infertility and get information about the most suitable treatment options for you. Vaccination is generally applied to couples in whom no problems are found in either partner despite all tests being performed. Apart from this, it is a very good option for men with premature ejaculation or erectile dysfunction, or for women with vaginismus that does not respond to treatment.

• The most important condition for a woman to receive IUI treatment is that her tubes are healthy. and it is open. There are some tests performed to show the patency and condition of the tubes. The most commonly used of these is HSG (hysterosalpingography), also called uterine film. Apart from this, there should be no serious problems with the uterus and ovaries.

• In a man, sperm parameters (number, motility, morphology) should not be excessively damaged. Mild-moderate

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