Instructions

Infertility and IUI

    • infertility
    In general, infertility refers to the situation whereby a couple fails to conceive after having sex two to three times per week for over a year without adopting any contraceptive measures after marriage. Infertility affects 15% of the total population of 22 million, which is about 300 to 350 thousand couples currently facing infertility to varying degrees in Taiwan. The problem not only brings trouble to the entire household but also directly affects the quality of family life and marital relationship between the husband and wife, which ultimately creates many other social issues. This is a serious problem to which the health unit of our government should attach greater importance. It is also the time for all relevant medical treatment institutions to give their helping hands and offer attentive concerns for female reproductive medical care.

    Generally speaking, the condition of infertility can be divided into two categories: primary infertility and secondary infertility. Primary infertility refers to patients who have never been pregnant before, whereas secondary infertility refers to patients who have been pregnant before but where the pregnancy resulted in abortion, ectopic pregnancy, stillbirth, or when the patient suffers the inability to become pregnant again after normal sexual relations.

    Normally, the peak of a female’s reproductive period falls beween the ages 21 and 25, which is the golden period for easy conception. The probability decreases to 75% within six months after the age of 25, and 47% for those who are around 30. When it comes to 30 to 35 and 35 to 40 years old, 38% and 25% are left separately for the women of this group. Only a 22% chance remains for females aged above 40. One can tell clearly from the statistics that the chance of conception for females diminishes with age, and the odds of abortion also rises relative to advancing age. This kind of phenomenon may be related to the cause of fetus chromosome abnormity which is more common in advanced maternal age. On the other hand, the quality of spermatozoa is likely to worsen as the husband ages, leading to the problem of chromosome abnormity at the same time.

    Therefore, we strongly advise that our fellow friends get married at the best age and give birth as early as possible to avoid the numerous issues brought by infertility.

     
    • Causes of infertility
    Infertility may came from male infertility accounts, female infertility accounts or common factors.
    Female infertility accounts for about 30 ~ 40%】Common causes include:
    1. Pelvic cavity: blocked fallopian tube or adhesion, pelvic adhesion
    2. Uterus: uterine tumor, uterine malformation, uterine cavity adhesion, cervical stenosis or atresia, endometriosis
    3. Ovary: ovulation disorders, Polycystic ovary syndrome, ovarian tumor, premature ovarian failure
    4. Endocrine: hyperprolactinemia, hyperandrogenism, progesterone deficiency
    5. Other reasons
    Male infertility accounts for about 30 ~ 40%】Common causes include:
    1. Penis: epispadias, hypospadias, phallocampsis
    2. Testicles: cryptorchidism, testicular torsion, testis atrophy, varicocele, accidental injury
    3. Sperm duct: congenital defect of the vas deferens, sperm duct inflammation
    4. Endocrine: Hypogonadism, hyperprolactinemia
    5. Other reasons
    Common factors】accounts for 5~10%:
    1. Immunity factors: husband's anti-sperm antibody or wife's anti-ovum antibody
    2. Other factors: aging, overweight, under high stress, environmental pollution, bad lifestyle, promiscuous, smoking, drug abuse
    3. Unknown reasons
       
    • Infertility Inspection
    Basic Inspection:
    1. Trans Vaginal Sona (TVS)
    2. Sperm Analysis(SA)
    3. Hyaluronan Binding Assay(HBA)
    4. Hysterosalpingogram(HSG)
    5. Hormonal study
    More Examination(recommended by your doctor):
    1. Laparoscopy(L-Scopy)
    2. Hysteroscopy(H-Scopy)
    Among them, sperm penetration analysis and 4D ultrasound are the unique infertility examination technologies of Lee Women’s Hospital.
     
    • Inspection Fee of Infertility
    Since the cost of infertility examinations varies from person to person, where different causes of infertility will require different examination methods to confirm the cause, therefore, if you want to perform infertility examinations, for a more complete detail, please make appointment with the infertility department and let a professional doctor evaluate the examination costs and items.
     
    • Treatment Methods of Infertility
    1. IUI
      IUI(Intrauterine Insemination)is suitable for legally married couples and is one of the methods used to treat infertility. Artificial conception mainly uses reproductive technology to screen out those spermatozoa with better mobility in the semen, and coordinate the timing with the wife’s menstrual cycle. It then uses artificial implantation tube to pass these washed spermatozoa through the vagina and cervix, and place them directly into the uterine cavity for the purpose of insemination. This is suitable for male infertility with low sperm count and poor mobility, as well as female infertility patients with polycystic ovary syndrome, endometriosis, and blocked fallopian tube.
       
    2. IVF
      This refers to the technology where after the retrieval of the sperms and eggs of the couple, with the help of reproductive techniques such as in vitro fertilization, the fertilized eggs are cultivated in the embryo culture room. After fertilization for several days, the well-developed embryo is implanted in the uterus to achieve pregnancy. This is suitable for infertile patients due to reasons such as blocked fallopian tube, fallopian tube defect, absence of fallopian tube, endometriosis, male infertility, female infertility, immunity factors and unknown causes. Lee Women’s Hospital’s Reproductive Medicine Center delivers Asia-leading reproductive technology, with its advanced 3.5-generation test tube baby technology, combined with an embryoscope time-lapse culture system and a high-resolution next-generation sequencing analysis platform (hr-NGS) which allows the observation of the growth of embryo can be without removing the embryo so that the best-developed embryo can be selected for implantation into the human body, thus greatly improving the success rate.

    ⋙ It is advisable for women to give birth early to avoid infertility
    The peak reproductive period of a woman is between 21 and 25 years old. This is the age most easily to conceived. After the age of 25 years old, the chance of conception for a woman within six months is 75%, around 30 years old the chance of conception is 47%, at the age of 30 to 35 years old it is 38%, at the age of 35 to 40 years old it is 25%, and at the age of 40 and above it becomes 22%. This data clearly shows that the probability of conception will decrease year by year with the increase in women's age. Moreover, the probability of miscarriage will also increase with age. This phenomenon may involve the reason that older women are more prone to fetal chromosomal abnormalities. In addition, as the husband’s age increases, the quality of his sperm will become relatively poorer, which will also affect the chromosome abnormalities. Therefore, we recommend that people at the suitable age for marriage should avoid late marriage and give birth as early as early possible, to avoid the many problems caused by infertility.
    • Intrauterine Insemination, IUI
    The principle is to select the most dynamic spermatozoa from the husband’s semen by means of reproductive techniques while coordinating with the wife’s reproductive cycle so as to implant the purified sperm directly into the uterus for further insemination through the vagina and cervical orifice at an appropriate timing with the application of embedded tubing.
     
    • Process of IUI
    The principle is to select the most dynamic spermatozoa from the husband’s semen by means of reproductive techniques while coordinating with the wife’s reproductive cycle so as to implant the purified sperm directly into the uterus for further insemination through the vagina and cervical orifice at an appropriate timing with the application of embedded tubing.

    Artificial insemination by husband(AIH)
    The males, for the most part, are required to abstain from sex for 3 to 4 days prior to providing the semen sample through masturbation. The semen will be placed inside a designated sterile essence containing bottle for 30 minutes at room temperature until liquefaction. Then the semen will be washed with sterile culture fluid before being separated by stratification and centrifugal methods in order to separate the vital and active sperm from the motionless and lifeless ones while eliminate impurities such as leukocyte, etc. As a result, the sperm with poor quality will be successfully screened out and the vigorous spermatozoa can thus be selected.
    人工受孕示意圖(英)
    • Cost of IUI
      The cost of IUI varies according to the actual treatment taken. Generally, the cost of artificial insemination will include the cost of injections and medicines, plus the cost of the surgery, such as: corpus luteum strengthening drugs, sperm treatment and implantation costs, ovulation injection costs, ultrasound, blood hormones testing costs, and so forth. The actual cost still depends on the course of treatment taken. Clinically, patients with fallopian tube obstruction, ovarian failure, or severe sperm abnormalities are not suitable for artificial insemination. If the husband’s sperm is normal and the wife's age is under 35 years old, there is about a 15-20% pregnancy rate for each artificial insemination, and the success rate will decline after more than 3 tries. For those wives who are over 35 years old, or have a lower ovarian reserve, or had 3 unsuccessful artificial insemination, then they will be recommended to switch directly to test tube treatment. The success rate of test-tube babies is 50~60%. If one added pre-implantation genetic screening (PGS) or time-lapse cultural system before embryo implantation, then the success rate can be increased greater to above 80%.
       
    • Applicable objects for IUI
      Male applicants for intrauterine insemination include men whose sperm are lacking of quantity and avidity, or who experience sexual dysfunction or abnormality and the uncommon retrograde ejaculation. Female applicants include women with symptoms of ovulation disorder or anovulation caused by polycystic ovary syndrome, slight fallopian tube adhesion and occlusion derived from endometriosis or pelvic inflammatory disease. Other targets suitable for intrauterine insemination are those with some unidentified reasons like anti-sperm antibody caused by immunity issues or other unknown causes which lead to infertility.
       
    • Spermatozoa Source
      Basically, the source of seminal fluid can be divided into two kinds: the semen provided by the husband himself (artificial insemination by husband, AIH) or by a known or anonymous sperm donor (artificial insemination by donor, AID). The semen contributed by the donor must be frozen for six-month and the blook must be screened again after six months to ensure there is no risk of AIDS prior to use.
       
    • Success rate / chance of IUI
      Clinically, artificial insemination is not suitable for patients with fallopian tube obstruction, ovarian failure, or severe sperm abnormalities. If the husband’s sperm is normal and the wife's age is under 35 years old, there is about a 15-20% pregnancy rate for each artificial insemination, and the success rate will decline after more than 3 tries. For those wives who are over 35 years old, or have a lower ovarian reserve, or had 3 unsuccessful artificial insemination, then they will be recommended to switch directly to test tube treatment. The success rate of test-tube babies is 50~60%. If one added pre-implantation genetic screening (PGS) or time-lapse cultural system before embryo implantation, then the success rate can be increased greater to above 80%.
       
    • Factors Influencing
      The factors which can affect the success rate of intrauterine insemination, IUI for males include bad habits such as smoking and excessive drinking, high temperature and polluted working environment, sauna enthusiasts, lovers of wearing jeans, or those with conditions such as varicocele, orchitis, or epididymis, etc. As for females, pelvic inflammatory disease, slight adhesion or oppilation of the oviduct, uterine fibroids, uterine polyps, uterine septum, and endometriosis, etc. are the major significant causes of artificial impregnation failures.