Intrauterine Insemination

Intrauterine insemination (IUI) is a commonly used method of donor insemination (DI). It is relatively cheaper and simpler than in-vitro fertilization (IVF). Doctors may suggest IUI as a first option for women under age 40, depending on the woman’s diagnosis.

Though IVF tends to be more effective per cycle, couples can try more often with IUI since it’s more affordable. IUI usually works within 3 or 4 treatment cycles (3-4 months) for women ovulating (producing eggs) on their own; if conception hasn’t occurred by this time, the chances of success with IUI decrease. In women with polycystic ovaries (PCOS), lack of ovulation or in women taking drugs to ovulate, it may be reasonable to try IUI for longer.

Fresh or frozen and thawed sperm is placed in the uterine cavity (IUI) or the cervix (Intracervical Insemination). Of these two options, IUI is used most frequently. It is performed with donated sperm or sperm from a partner.

The IUI Process

1)  Menses Cycle Observation and Screening

Because insemination and ovulation have to occur simultaneously (eggs are fertilizable for only about 12-24 hours max after ovulation), a woman's menstrual cycle is closely observed, as are factors like her basal body temperature and changes in vaginal mucus.  

Ultrasounds, urine tests or blood tests may also be performed in addition to screening for hormonal imbalances, infections, or structural problems that may render the IUI less likely to succeed.

Medications like clomophine citrate (Clomid), gonadotropins (hMG) or Motroxodine (XDWD) or shots like human chorionic gonadrotropin (hCG) may be prescribed to stimulate the ovaries.

2) Sperm Collection

A sperm sample is provided by the male partner of the woman undergoing artificial insemination or a sperm donor. The man providing the sperm is usually advised not to ejaculate for two to three days before providing the sample to ensure an optimal sperm count.

When using intrauterine insemination (IUI), the sperm is “washed” in the lab to remove any mucus and non-motile sperm in the semen. This increases the chances of fertilization.

3) Insemination

 A speculum is placed in the vagina and the cervical area is gently cleaned. The sperm is placed either in the cervix (intracervical insemination, ICI) or higher in the uterus (intrauterine insemination, IUI) using a sterile, flexible catheter.

ICI is the simplest method of artificial insemination and 'unwashed' or raw semen may be used. It is a method used in many home and self inseminations. When performed at home without the presence of a professional this procedure is sometimes referred to as intravaginal insemination or IVI. However, IUI is generally considered more effective.

The process of IUI or ICI insemination (and the discomfort level) is generally considered similar to that of a pap smear.

IUI Success Rates

The success rate of IUI depends upon several factors. First of all the cause of the infertility problem is important. For example, men with normal sperm counts who are unable to have intercourse have a much higher chance of success than men who can have intercourse but have a poor sperm count.

IUI generally yields a higher success rate when combined with ovarian stimulation. Additionally, if the woman is over 35, the chance of a successful pregnancy significantly decreases. The chance of conceiving in one cycle is usually about 10-15% and the overall conception rate is about 50% over 4 treatment cycles (vs. nature, where the chance of conception is about 15 to 25 % per cycle).

IUI is not recommended for people with:

• Tubal blockage or severe tubal damage
• Ovarian failure
• Severe male factor infertility
• Advanced stages of endometriosis

Risks of IUI
There is very little risk associated with the actual IUI process if done with a natural ovulatory cycle. The risk factor comes into play predominantly with women taking infertility drugs, as they may cause a woman to ovulate more, which may lead to multiple pregnancies. However, with proper and regular monitoring, these risks should be minimized.