Intrauterine Insemination (IUI)

Intrauterine insemination (IUI) is a fertility procedure in which sperm are washed, concentrated, and injected directly into a woman's uterus. In natural intercourse, only a fraction of the sperm make it up the woman's genital tract. IUI increases the number of sperm in the fallopian tubes, where fertilization takes place. This page discusses the following topics:

• Candidates  
   
• Benefits 
   
• Risks 
   
• Procedure

Studies show that IUI is most successful when it is coupled with fertility drugs to enhance ovulation. This technique is often called controlled ovarian hyperstimulation and IUI.

Candidates

IUI is usually recommended for couples with no known cause of infertility who have been trying to have a baby for at least one year. You should have a thorough infertility investigation before trying IUI.

Under normal circumstances, IUI uses sperm from the male partner. However; another insemination technique, artificial insemination by donor (AID) or therapeutic donor insemination (TDI), uses screened sperm samples from anonymous donors.

Reproductive Science Center adheres to the guidelines of the American Society for Reproductive Medicine regarding the use of donor sperm. It is the ASRM's position that under present circumstances, the use of fresh semen for donor insemination is not warranted. All frozen specimens should be quarantined for 180 days and the donor should be retested and found to be seronegative for HIV before the specimen is released. This position is consistent with our goal to provide safety for patients undergoing this procedure.

Male partner requirements - IUI relies on the natural ability of sperm to fertilize an egg within the reproductive tract. Studies show that IUI will not be effective in cases where the male has low sperm counts or poor sperm shape. Sperm tests should show reasonable sperm function:

• sperm count (number of sperm per cc)
   
• mobility (percentage of sperm moving)
   
• sperm morphology (shape).
   
• in addition, in the State of California, the male partner must have blood work done to rule out certain infectious diseases.

Female partner requirements - The female partner should have no obvious fertility problems. Tests should show normal ovulation, open fallopian tubes, and a normal uterine cavity.

• Women with ovulatory disorders can be candidates for IUI if they respond adequately to fertility drugs. In these cases, hormone treatments stimulate ovulation, and the IUI is timed to take place around the time of ovulation. Hormone treatments are usually used even for women without ovulatory disorder.
   
• Women with endometriosis may benefit from IUI if they do not have a distortion of the pelvic structures. Women with mild endometriosis are usually treated similarly to women with unexplained infertility.
   
• Women with severely damaged or blocked fallopian tubes will not be helped by IUI.

The success rates of superovulation (from hormone treatment) and IUI are between 5 and 15 percent per cycle (dependent on the woman's age) provided that the male partner's sperm count is within normal limits and the female's tubes are healthy.

Doctors might try three cycles of IUI and, if these are not successful, then recommend more advanced methods such as in vitro fertilization (IVF).  Unlike IVF, IUI does not involve egg collection or general anesthetic.

While complications of IUI are infrequent, they can include infection, brief uterine cramping, or transmission of venereal disease (from donor semen). 

Risks of the hormone treatment for controlled ovarian hyperstimulation include multiple pregnancy and Ovarian Hyperstimulation Syndrome (large ovaries and collection of fluid in the abdomen). If more than three follicles mature, there is a risk of multiple pregnancy. Your doctor may choose to stop the treatment cycle. Multiple pregnancies tend to have higher rates of miscarriage, lower birth-weight babies, and greater social difficulties. Your doctor may also stop the cycle if you have Ovarian Hyperstimulation Syndrome, a rare effect. Too high a dose of drug can cause excessive stimulation of the ovaries, which you may notice as pain in the abdomen.

1. Drug treatment, to encourage two or three eggs to mature. Usually Clomiphene pills or gonadotropin injections are used to stimulate the growth of follicles and cause ovulation.

2. Monitoring of treatment, to measure the growth of follicles, individualize drug doses, and prevent serious side effects. Because fertility drugs can produce several eggs, your doctor must monitor your progress during an IUI cycle for side effects and to reduce the risk of multiple pregnancy. The clinic will do blood tests to measure estrogen concentrations and use ultrasound to track the development of follicles. The usual aim in IUI is to generate three to five mature follicles.

3. When two or three follicles have reached their target size, you will get an injection of the hormone hCG to induce ovulation.

4. Sperm sample, provided on morning of ovulation, is prepared and inseminated later that day. The fresh semen is collected by the male, then washed and concentrated. Using a fine catheter, the doctor inserts the sperm through the cervix and high into the uterus of the female partner. The procedure is fairly painless, comparable to a Pap test.

5. Pregnancy testing and early ultrasound monitoring