If you are finding it harder to fall pregnant than you expected, be assured you are not alone. About one in seven couples are affected by infertility in Singapore.
One of the most common solutions to infertility is intrauterine insemination. It has stood the test of time and has increasingly gained momentum in Singapore.
In Singapore, about 2,000 cycles of IUI are attempted by couples each year.
What is intrauterine insemination (IUI)?
It is a modality of treatment of infertility where washed and processed sperm cells from your male partner or donor sperms are directly injected into the uterus while bypassing the cervix and the vagina.
The rationale of doing this is that in some women, the vaginal environment is highly acidic, and the cervical mucus is too hostile for the sperms to survive, hence the need to bypass them through IUI.
Who should undergo IUI?
Couples with the following fertility problems are suited for IUI.
Male factors include:
- Anatomical defects in the penis, such as hypospadias (urethra opening on the lower side of the penis)
- Low sperm count or production of no sperms at all.
- Erectile dysfunction (inability to achieve or sustain an erection long enough to experience ejaculation).
- Endocrine abnormalities
Female factors include:
- Anatomical defects that make sexual intercourse impossible such as an imperforate hymen.
- Hostile cervical mucus which may contain antibodies to sperm cells
- Vaginal spasms (tightening of your vaginal muscles, preventing penetration.)
- Destruction of the cervix through surgery
What does the process of intrauterine insemination entail?
First, your doctor will have to do some diagnostic examination. This entails understanding your history, doing a thorough body examination, and ordering some lab works for both you and your partner.
For the male partner, the doctor’s evaluation will entail a detailed history and a physical examination, a seminal analysis, morphology and sperm function tests, a screen for infections like HIV, syphilis, and hepatitis B, and hormonal profile.
For the female partner, the doctor will, on top of the history and examination, order for an ultrasound, hysterosalpingogram, which is basically an imaging procedure enabling visualization of the entire uterus and tubes for any obstruction or structural changes.
The examination will also involve follicular growth monitoring through ultrasound, cervical mucus studies, detection and timing of ovulation, testing for infections like chlamydia and trichomonas, as well as doing a hormonal profile.
IUI Procedure Step by Step
The whole Intrauterine Insemination involves around four steps. This may vary depending on the clinic you attend;
Step 1: Sperm Collection and Processing
The man’s semen will be collected, or for those who don’t have partners, sperms can be obtained from sperm donors before the start of the actual IUI. You can choose to do the sperm collection at home or in the hospital.
The sperms are usually collected in a sterile container that will be provided by the labs. The sample must then be sent to the lab within the stipulated timelines and storage conditions to ensure optimal quality.
Step 2: Ovulation Induction and Monitoring
To increase the chances of pregnancy, women undergoing IUI are usually given drugs like clomiphene or raloxifene before insemination.
These drugs are taken from day 2 of the menstrual cycle. They stimulate the pituitary, which is an endocrine organ in the brain, to produce the Follicular stimulating hormone and Luteinizing hormone, which in turn stimulate your ovaries to produce eggs.
The drugs have mild side effects like nausea, vomiting, diarrhoea, and mild abdominal pain. The more severe side effects include shortness of breath, severe abdominal pain, decreased urination, and rapid weight gain.
Collectively, these symptoms are referred to as ovarian hyperstimulation syndrome. It is advisable to contact your doctor if you experience any of them.
During the treatment, your doctor will monitor the growth of eggs in your ovaries and use the information to time your ovulation accurately.
He could decide to give you an HCG (human chorionic gonadotropin hormone) injection to stimulate ovulation, which will be expected to happen within 34-36 hrs after the injection.
Step 3: Placing the sperms in the uterus
Once ovulation has been induced or identified, your doctor will book you for the IUI procedure. Under clean and sterile conditions, the doctor will ask you to lie on an examination couch.
He will then proceed to examine you and clean your cervix before inserting the sperms into the uterus using a catheter . After the insemination, you will be advised to lie facing up for around 30-60 minutes.
Step 4: Test for conception
Two weeks after insemination, a pregnancy test will be done to determine if the procedure was successful. This is the most anxious part for most patients.
However, as you wait, you can boost your chances of conceiving by avoiding strenuous activities or exercise.
It is also advisable to take prenatal vitamins like folic acid and eat balanced meals to prepare the body and create a more ideal condition for a baby to grow.
How Much Does IUI Cost?
The cost per cycle of IUI in Singapore is between $1000 – $1500.
What is the amount of Government subsidy for IUI in Singapore?
Eligible couples undergoing Assisted Conception Procedures (ACPs) in public Assisted Reproduction (AR) centres can undergo IUI for a maximum of 3 cycles.
For IUI Co-Funding:
- You are below 40 years of age at the start of the IUI cycle;
- You have been assessed by a doctor at the public AR centre to be suitable to try IUI before proceeding to ART; and
- You OR your spouse must be a Singaporean Citizen.
The amount of subsidy (co-funding) for IVF depends on the citizenship of the couple.
Co-funding per Treatment Cycle
Singapore Citizen couple
75%; up to $1,000
55%; up to $700
35%; up to $500
Government subsidy for IUI at Private Fertility Clinics
Should you choose to go for IUI at a private fertility centre or a private hospital, there is currently NO subsidy (co-funding) available from the Government.
Do I have to apply for IUI Government Subsidy (Co-funding scheme)?
You will only need to fill up a declaration form provided by the hospital, which will be used to check your eligibility for the co-funding scheme.
Once the hospital has verified that you are eligible to receive co-funding, the hospital will incorporate it into your bill.
Can I use Medisave for IUI in Singapore?
Yes you can! If you choose to go to a public Assisted Reproduction (AR) centre at a public hospital, you can also enjoy the subsidy (co-funding) provided by the government on top of using your Medisave.
Regardless of private or public, couples can withdraw the following amounts from Medisave for IUI.
Medisave Withdrawal Limit
3rd treatment (if applicable)
Lifetime Withdrawal Limit
Is the government subsidy (co-funding) available at private hospitals?
No. Similar to general healthcare subsidies, the IUI co-funding scheme only applies for IUI treatment done at public hospitals.
Patients can still use MediSave for IUI treatment performed at private hospitals up to the prevailing withdrawal limits.
How Does the IUI Experience Feel Like?
Well, Sarah Ong, a lifestyle writer, says that while IUI itself was uncomfortable, it didn’t hurt. She says that it felt like a pinch during catheter insertion and compared it to a pap-smear test.
What she dreaded most was the two-week wait for the pregnancy test. The side effects, she says, were minor cramping, spotting, and fullness post-procedure but added that it was all worth it because she finally became pregnant.
What is the IUI Success Rate in Singapore?
The success rate of IUI in Singapore ranges between 15% – 20%.
What is Superovulation & Intrauterine Insemination (SO-IUI)?
Superovulation is a procedure where two to three ovarian follicles (eggs) are stimulated and brought to maturation and ovulation.
This procedure is usually combined with intrauterine insemination in which the prepared sperm is placed directly into the uterus.
SO-IUI will enhance conception for the couple.
How Does IUI Differ From In-Vitro-Fertilization (IVF)?
In IUI, the process of fertilization takes place within your body, while in IVF, your egg and your partner’s sperms are mixed outside the body and transferred into your uterus after fertilization and embryo formation.
Also, in IUI, the risk of multiple pregnancies like twins is increased because of ovarian stimulation, while in IVF, it’s less likely as only one embryo is transferred after fertilization.
The cost of IUI is also relatively cheaper than IVF. The success rate of IVF is, on the contrary, much higher than IUI.
Don’t Let Infertility Hold You Back; Try IUI
Intrauterine insemination is a safe and viable option for couples struggling with infertility to explore.
In Singapore, other than the availability of specialists and facilities, the procedure is reasonably affordable. It also has success rates similar to healthy couples having regular intercourse.
Plus, there is no limit as to how many times you can go for IUI, though government co-funding is for a maximum of 3 cycles.
Now that you know what IUI can do for you, don’t give up on your dream of having a family. Visit a gynaecologist in Singapore and discuss your options with them.