Intra-Uterine Insemination (IUI) artificial insemination is placement of sperm directly into uterus for the purpose of enhancing the chance for pregnancy. The goal of IUI is to increase the number of sperm that reach the fallopian tubes and subsequently increase the chance of fertilization.
IUI is a fertility treatment often selected by couples who have been trying to conceive for at least one year with no success. IUI may be selected as a fertility treatment with any of the following conditions ;
- Unexplained infertility
- Low sperm count
- Decreased sperm mobility
- Requirement of donor sperm
- A hostile cervical condition, such as cervical mucus that is too thick
- Cervical scar tissue from past procedures or endometriosis
- Ejaculation dysfunction
The IUI procedure is simple and may be performed even if the woman is not receiving medication to improve her egg production. Many physicians will encourage women to take medications to stimulate the ovaries to increase egg production in order to improve the chance of achieving pregnancy.
Once IUI is recommended there will be 2 methods to know their ovulation cycles to time out correct insemination period.
One method is using ovulation predictor kit where detecting woman’s LH surge (luteinizing hormone which surges as ovulation occurs). The surge peaks about 12-24 hours before the egg is released. A woman will test her urine in the morning. If the test is positive, she would have the IUI the next day.
Second method is through artificially triggering ovulation. A medication called HCG can be injected where ultrasound determines that the egg or eggs developing in her ovaries are mature enough to be released. Once your doctor gives you the HCG trigger shot, they usually perform the IUI the next day or with in 2 days . Ovulation will occur approximately 24-36 hours after HCG trigger shot.
Sperm Wash :
IUI can be performed either with the partner’s sperm or with donor sperm. The male partner or donor is asked to produce a semen sample by masturbation, one hour before the IUI procedure is to be performed or a prior collected frozen semen sample can be inseminated.
It is recommended that the patient abstain from sexual intercourse for two to three days before the procedure. Before insemination the semen is washed in lab to not harm sperm increases the motility and morphology. A washed specimen can be safely stored for up to 6 hours in cases where Insemination is delayed.
Sperm wash allows time for the sperm to liquefy in incubator and prepare for the IUI.
Process of IUI :
This insemination procedure is simple and takes about 5-10 minutes, usually being painless. A speculum is inserted into the vagina to visualize the cervix. A mild cleaning solution may be used to clean the cervix and surrounding vaginal tissue. The washed sperm will be drawn into a syringe with a tiny catheter attached. The catheter is passed through the cervix and then the sperm injected into the uterus. The catheter and speculum will then be removed and the patient may be asked to rest for a short period of time, approx 10 -15 mins .
After the IUI is completed, the patient can resume any activities she likes for the rest of that day. There is no need of bed rest in the IUI procedure.
It is OK for a couple to have intercourse after an IUI is performed. In fact, for men with low sperm counts, having intercourse in addition to the IUI will increase the total amount of sperm in the uterus and may improve the chance for pregnancy.
Usually, an IUI does not cause much discomfort for a woman. Most women say that it is about the same as having a pap smear. There can be some cramping afterward, but most of what is felt is probably due to ovulation rather than from the IUI itself.
Success Rate for IUI :
The success rate of IUI depends on multiple factors like age of the female, ovarian function, fallopian tube blockage, pelvic adhesions, sperm motility, using fertility medications and others. If an IUI is attempted without any fertility drugs, the chances of conception are less.
Women under the age of 35 usually have higher rates of success than women over age 35, but the average success rate for IUI ranges from 10-20% in one cycle.
With IUI, the success rate depends primarily on the health of both the sperm and the woman.
One important factor that is specific to IUI is the amount of motile sperm that is inserted into the uterus. If a man has a high percentage of abnormal appearing sperm on a semen test, that will also lower the chances for success.
Another important is timing of the IUI performed. Sperm must be inseminated on the same day as ovulation which maximize the chances for IUI success.
There is not much advantage to performing an intrauterine insemination twice. Several well done studies comparing the pregnancy rates between couples having a single insemination to those having two Insemination have found no significant difference in the pregnancy rates.
However, IUI is recommended to 3-4 cycles, before moving onto IVF treatment . As success rate dropped significantly to only 5.6%.
IUI is an uncomplicated low risk, low cost, effective form of therapy can usually be sought first, before moving over to more pricey and invasive options.