Intrauterine insemination (IUI) is a fertility treatment that involves placing sperm inside a woman’s uterus to facilitate fertilization. The goal of IUI is to increase the number of sperm that reach the fallopian tubes and subsequently increase the chance of fertilization. IUI provides the sperm an advantage by giving it a head start, but still requires a sperm to reach and fertilize the egg on its own. It is a less invasive and less expensive option compared to in vitro fertilization.
The most common reasons for IUI are a low sperm count or decreased sperm mobility.
• Unexplained infertility
• A hostile cervical condition, including cervical mucus problems
• Cervical scar tissue from past procedures which may hinder the sperms’ ability to enter the uterus
• Ejaculation dysfunction
• Women who have severe disease of the fallopian tubes
• Women with a history of pelvic infections
• Women with moderate to severe endometriosis
Before intrauterine insemination, ovulation stimulating medications may be used, in which case careful monitoring will be necessary to determine when the eggs are mature. The IUI procedure will then be performed around the time of ovulation, typically about 24-36 hours after the surge in LH hormone that indicates ovulation will occur soon.
A semen sample will be washed by the lab to separate the semen from the seminal fluid. A catheter will then be used to insert the sperm directly into the uterus. This process maximizes the number of sperm cells that are placed in the uterus, thus increasing the possibility of conception. The IUI procedure takes only a few minutes and involves minimal discomfort.
The chances of becoming pregnant with multiples is increased if you take fertility medication when having IUI. There is also a small risk of infection after IUI.
The success of IUI depends on several factors. If a couple has the IUI procedure performed each month, success rates may reach as high as 20% per cycle depending on variables such as female age, the reason for infertility, and whether fertility drugs were used, among other variables. While IUI is a less invasive and less expensive option, pregnancy rates from IUI are lower than those from IVF. If you think you may be interested in IUI, talk with your doctor to discuss your options.
If you are not using fertility drugs, IUI will be performed between day 12 and 16 of your monthly cycle – with day one being the first day of your period. You will be given blood tests or urine tests to identify when you are about to ovulate.
If you use fertility drugs to stimulate ovulation, vaginal ultrasound scans are used to track the development of your eggs. As soon as an egg is mature, you are given a hormone injection to stimulate its release.
The sperm will be inserted 36–40 hours later. The doctor will first insert a speculum into your vagina, as in a smear test, to keep your vaginal walls apart. A small catheter (a soft, flexible tube) will then be threaded into your womb via your cervix. The best-quality sperm will be selected and inserted through the catheter.
The whole process only takes a few minutes and is usually painless. Some women may experience a temporary, menstrual-like cramping. You may want to rest for a short time before going home.
You will be asked to produce a sperm sample on the day the treatment takes place.
The sperm will be washed to remove the fluid surrounding them and the rapidly moving sperm will be separated out from the slower sperm.
The rapidly moving sperm will be placed in a small catheter to be inserted into the womb.
If you are using donated or frozen sperm, it will be removed from frozen storage, thawed and prepared in the same way.
Intrauterine insemination is a relatively simple and safe procedure, and the risk of serious complications is low. Risks include:
• Infection. There's a slight risk of developing an infection as a result of the procedure.
• Spotting. Sometimes the process of placing the catheter in the uterus causes a small amount of vaginal bleeding. This doesn't usually have an effect on the chance of pregnancy.
• Multiple pregnancy. IUI itself isn't associated with an increased risk of a multiple pregnancy — twins, triplets or more. But, when coordinated with ovulation-inducing medications, the risk of a multiple pregnancy increases significantly. A multiple pregnancy has higher risks than a single pregnancy does, including early labor and low birth weight.
• Hot flashes.
• Mood swings and depression.
• Nausea, headaches or visual disturbances.
• Swollen and painful ovaries, signaling ovarian hyperstimulation syndrome (OHSS)
• Pelvic discomfort, breast tenderness, or bloating.
• Ovarian cysts.