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. IUI is usually recommended for couples with no known causes of infertility who have been trying to have a baby for at least one year. It is a reasonable initial treatment that should be utilized for a maximum of 3–6 months in women who are ovulating (releasing eggs) on their own.
It should not be used for women with blocked fallopian tubes. Therefore, tubal patency should be investigated through the testing of an x-ray study called a hysterosalpingogram (HSG). It has very little chance of working with women that are over 40 years of age and in younger women with a significantly elevated CD3 FSH level or other indication of reduced ovarian reserve.
In many cases, IUI uses sperm from the male partner. However, another insemination technique called therapeutic donor insemination (TDI) uses screened sperm samples from anonymous donors. East Bay Fertility Center adheres to the guidelines of the American Society of Reproductive Medicine (ASRM) regarding the use of donor sperm.
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 a low sperm count or poor sperm shape (morphology). In that situation, in-vitro fertilization with ICSI is indicated and has high success rates. In the State of California, the male partner must have blood tests to rule out certain infectious diseases.
How is insemination performed?
Typically the female partner is stimulated with medications to produce multiple egg development, meaning the aim is to produce two or three eggs to maturity. Usually Clomiphene (clomid) pills or gonadotropin injections are used to stimulate the ovaries to produce follicles and cause ovulation. In situations where there are no male or female factors, a natural cycle IUI can be performed. That is, simply following the female partner's LH surge through the use of an ovulation predictor kit can time the insemination base on her natural cycle without the use of medications.
However, if a patient is using medications to stimulate egg development, monitoring the patient through the use of ultrasound is important because it allows the doctor to measure the growth of the follicles. Fertility drugs can produce many eggs and your doctor should monitor your progress during the cycle for any possible side effects to you and to reduce the risk of multiple pregnancy. Sometimes a blood test will be taken to measure estrogen concentrations along with the ultrasound to track egg development.
The usual aim of IUI is to generate three to five mature follicles. When two or three follicles have reached their target size, the patient may take an injection of the hormone hCG to induce ovulation.
At the time of anticipated ovulation, a fresh sperm sample is prepared by being "washed" in the lab. This process separates the sperm from the other components of seminal fluid. The sperm washing process takes about 20–60 minutes depending on the technique utilized. The separated and washed sperm consists of highly motile sperm and is then placed in the cervix or high in the uterine cavity using a very thin, soft catheter. The procedure is fairly painless, often compared to a Pap test.
Typically the woman remains lying down for about 5–15 minutes following the procedure. The sperm does not "leak out" when the woman stands up as the sperm has been deposited high in the uterine cavity.
It is important to note that pregnancy rates are lower when insemination is used
- in women over 40 years of age
- in women with poor egg quality and quantity
- with poor sperm quality
- in women with moderate or severe endometriosis
- in women with any degree of tubal damage or pelvic scar tissue
Success rates are slightly higher with women who do not ovulate on their own (anovulation) and are stimulated with medication and then inseminated because it is more likely the sole cause of their infertility is their ovulation disorder, which is overcome with the use of ovulation stimulating medication.
Insemination combined with injectable gonadotropins seems to provide better pregnancy rates (and higher multiple pregnancy rates) as compared to insemination combined with Clomiphene. This is because injectable medications stimulate more mature eggs to develop than does Clomiphene and more mature follicles and eggs lead to an increased chance of pregnancy. The potential drawback is that it also increases the risk for multiple pregnancy.
IUI therapy is usually not recommended for more than 4–6 cycles. In-vitro fertilization is the next step in treatment after inseminations and has a much higher success rate per cycle. However, IVF is more invasive and much more expensive than insemination. Therefore, unless there is tubal damage or poor sperm quality, 2–4 insemination cycles are usually attempted before moving on to IVF.
Benefits to IUI
IUI does not involve egg collection (IVF) or general anesthetic. The success rates can vary dependent on a variety of factors, not the least are the woman's age, unblocked tubes and the partner's sperm count being within normal limits.
Risks of IUI
Complications arising from IUI are very infrequent but can include infection or uterine cramping.
Costs of IUI
Charges for insemination with partner's sperm, includes the process of sperm washing, medication (Clomiphene, injectable gonadotropins), ultrasound, and blood tests. Please call us for our current charges for intrauterine insemination.