IUI Intrauterine Insemination

Introduction

Intrauterine insemination (IUI) is also called artificial insemination. Human artificial insemination with the male partner’s sperm for infertility began being used in the 1940?s. The IUI procedure can be an effective treatment for some causes of infertility in women under age 41. IUI is commonly used for unexplained infertility. It is also used for couples affected by mild endometriosis, problems with ovulation, mild male factor infertility and cervical factor infertility.

IUI may not effective in the case of:

1. Ovarian failure (menopause)

2. Tubal blockage or severe tubal damage

3. Severe endometriosis

4. Severe male factor infertility

IUI has been shown to have a reduced success rate in:

1. Women over 40 years old.

2. Younger women with significantly high day 3 FSH levels

IUI is utilized:

1. As a reasonable initial treatment in women who are ovulating on their own – for about 3 months’ time

2. In women with polycystic ovary syndrome (PCOS) and lack of ovulation that have been given drugs to ovulate. Here the treatment may be for more than 3 months.

Procedure

1. Medications are given to the woman to stimulate the development of multiple eggs and insemination is timed to coincide with the release of the eggs.

2. A semen specimen is produced either at home or in the clinic by masturbation after 2-5 days of abstinence from ejaculation.

3. Sperm processing/ washing- The semen is “washed” in the laboratory. Various media and techniques can be used for the washing and separation. Sperm processing may require around 30 minutes to an hour. The sperm is separated from the other components of the semen and concentrated in a small volume.

4. A speculum is placed in the vagina and the cervical area is gently cleaned.

5. The washed specimen of highly motile sperm is placed either in the cervix (intracervical insemination, ICI) or higher in the uterine cavity (intrauterine insemination, IUI) using a sterile, flexible catheter.

6. The intrauterine insemination procedure, if done properly, should seem similar to a pap smear for the woman. There should be little or no discomfort.

7. Precaution- Many clinics request patients to remain lying down for a few minutes after the procedure, although it has not been shown to improve success. The sperm has been put above the vagina and cervix – it will not leak out when you stand up.

Success rates for IUI

For a couple with unexplained infertility who are trying for two years, where the female is under 35 years and the male is producing normal sperms, the possibilities are as given below-

1. 10% chance per month of getting pregnant and having a baby with artificial insemination

2. 15% chance per month of getting pregnant and having a baby with injectable FSH medication and IUI for up to 3 cycles

3. 55% chance of conceiving and having a baby with 1 IVF

IUI generally fails to work if the sperm count, motility and morphology scores are low. Chances for success in women over 35 drop off, and for women over 40 they are much lower. For this reason, we are more aggressive in older women.

Cervical vs. intrauterine insemination:

IUI is more effective than intracervical insemination (ICI). By placing the sperm higher in the female reproductive tract, more sperm will get to the area in the fallopian tube where they might have a successful date with the egg(s).

Importance of timing in the IUI procedure:

1. Any insemination should be carefully timed to occur at or a little before the time of ovulation, though it is known that- in some couples, sperm can remain viable in the female reproductive tract and result in fertilization of an egg for five days (after having sex).

2. Eggs are fertilizable for only about 12-24 hours (maximum) after ovulation. Hence, IUIs must be properly timed so that sperm show up for the date while the eggs are still viable.

Risks of artificial insemination in women:

1. There lies a little risk for complications with intrauterine insemination

2. The woman could develop an infection in the uterus and tubes from bacterial contamination that originated either in the semen sample, or through a contamination of the sterile catheter in the vagina or cervical area during the procedure.

3. Careful cleaning of the cervix and cautious technique can be helpful in avoiding any possible infection during the procedure.