What is Intrauterine Insemination (IUI)?
Intrauterine insemination (IUI), also known as artificial insemination, is an infertility treatment in which a woman is injected with specially prepared, or “washed” sperm. The concentrated sperm are injected directly into the woman’s uterus the day after an egg (s) is released by one of her ovaries. The goal is for the sperm to swim into the fallopian tubes to fertilize the egg, resulting in pregnancy. In some cases, the woman will take fertility medications to stimulate ovulation prior to the procedure, while in others; the procedure will be coordinated with a woman’s normal cycle.
Who is a candidate for IUI?
IUI is typically used to treat those with:
- Mild male factor infertility – low concentration of sperm, weak motility, or abnormalities in sperm size or shape.
- Cervical factor infertility – cervical mucus produced around ovulation enables sperm to travel from the vagina to the fallopian tubes. When it is too thick, sperm cannot pass. IUI is used to bypass the cervix by placing sperm directly into the uterus.
- Unexplained infertility – IUI can be the first line of treatment when the cause of infertility is unknown.
- Women using donor sperm – donor sperm is thawed prior to the procedure and injected directly into the uterus of a woman wishing to become pregnant.
- Semen allergy – in rare cases, women are allergic to proteins in their partner's semen, and ejaculation into the vagina causes redness, burning and swelling, even hives and difficulty breathing. During IUI many of the semen proteins are removed before sperm is inserted, to prevent allergic reaction.
Women with blocked or damaged fallopian tubes are not candidates for this procedure.
How is IUI performed?
The first step in an IUI procedure is to collect the semen sample, which is provided by the man at the doctor’s office in advance of the procedure being performed. Alternatively, if a woman is using donor sperm, a vial of semen will be thawed and prepared. Because there is a higher chance of pregnancy when a small, yet highly concentrated amount of sperm is used, the sperm sample is “washed,” in a process that clears away any lower quality sperm, as well as other debris that might reduce its effectiveness. Semen will be analyzed for sperm count, motility, and for diseases. Samples are screened for HIV-1 and 2 antibodies, Hepatitis B surface antigen, Hepatitis C antibody, Cytomegalovirus (CMV), and Syphilis (RPR).
The woman will be monitored for signs of ovulation to ensure that the IUI procedure is done at precisely the right time. A physician can detect ovulation with the use of an ultrasound machine that enables him or her to view a woman’s ovaries and the growth of eggs. Some women monitor their own ovulation cycle with home predictor kits.
If IUI is being coordinated with a woman’s normal ovulation cycle, she will have the procedure performed the day after she detects a surge in luteinizing hormone (LH). This occurs just before ovulation. If fertility medications are being used to stimulate ovulation, the woman may be given an injection of human chorionic gonadotropin (hCG) to initiate ovulation the day before insemination is scheduled to be performed.
During the procedure, the woman lies on an exam table with her legs in stirrups. A speculum is inserted into the vagina, followed by a catheter (a long, thin tube), which will go through the cervical opening and into the uterus. The sperm sample, which is attached to a syringe at the end of the catheter, is then pushed through the tube into the uterus. The entire process takes approximately 20 minutes in the doctor’s office. Following the procedure, the woman lies on her back for a short time before returning to her daily routine.
After two weeks, a home pregnancy test is taken or a blood test given at the doctor’s office to determine whether the procedure was successful and resulted in pregnancy. In cases of unsuccessful attempts at IUI, women and/or couples are often encouraged to try again before trying other, more invasive fertility treatments. The chances of success of subsequent IUI procedures can be enhanced by increasing the dosage of fertility medication used prior to the procedure.
What are the risks of IUI?
IUI is a fairly simple and safe procedure. Risks associated with IUI are low, but some do exist. They include:
- Infection resulting from the procedure itself - Infection occurs in fewer than 1% of women undergoing IUI.
- Some women report minor cramping after the procedure.
- If fertility drugs are used to induce ovulation, there may be side effects such as nausea
- Multiple pregnancies - Especially in cases when injected fertility medications are used to facilitate ovulation, the risk of multiple pregnancies increases significantly. The risks associated with multiple pregnancies include early labor and low birth weight.
What is the cost?
Intrauterine insemination is covered by most insurance plans. Each cycle costs patients between $300 to $800 dollars depending on the clinic.
What is the success rate?
Women under age 35 have about a 10% chance of becoming pregnant per attempt with IUI. If injectable fertility drugs are used such as gonadotropin, the chance of successful pregnancy rises to between 15% and 20%. These success rates are much lower for women over 35.