IUI: Intrauterine Insemination
IUI: Intrauterine Insemination
Intrauterine insemination (IUI) is a fertility procedure in which sperm are washed, concentrated, and injected directly into a woman's uterus. The most common indications for IUI are cervical mucus abnormalities, low sperm count, low sperm motility, increased sperm viscosity or antisperm antibodies, unexplained infertility, and the need to use frozen donor sperm. In natural intercourse, only a fraction of the sperm make it past the woman's cervical mucus into the uterus. IUI increases the number of sperm in the fallopian tubes, where fertilization takes place.
Studies show that IUI is most successful when it is coupled with fertility drugs that recruit multiple follicles. This technique often is called controlled ovarian stimulation and IUI.
IUI sometimes is recommended for couples with unspecified infertility who have been trying to have a baby for six to 12 months. You should have a thorough infertility evaluation before trying IUI.
Male Partner Requirements for IUI
IUI relies on the natural ability of sperm to fertilize an egg in the fallopian tubes. Studies show that IUI will not be effective in cases where the male has low sperm counts or poor sperm shape (also known as sperm morphology). Sperm tests are required, therefore, in order to indicate:
- Sperm count (number of sperm per cc)
- Sperm motility (percentage of sperm moving)
- Sperm morphology (shape)
In addition, California state law requires that the male (or female) partner must have blood work done to rule out certain infectious diseases.
Female Patient Requirements for IUI
The patient should have normal day 3 blood test results, 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 follicle growth and the IUI is timed to take place after ovulation is induced. Hormone treatments are usually used even for women without ovulatory disorder.
- Women with mild endometriosis may benefit from IUI if they do not have a distortion of the pelvic structures.
- Women with severely damaged or blocked fallopian tubes are not candidates for IUI.
Intrauterine Insemination Procedures
IUI is timed as closely to ovulation as possible, therefore you will be monitoring your cycle with an ovulation predictor kit and/or we will control the time of ovulation with hCG. The insemination is accomplished by placing a speculum in the vagina to visualize the cervix in a procedure position similar to a Pap smear. A small, sterile catheter containing the sperm will be inserted through the cervical opening into the uterine cavity next to the tubal openings. Depending on which type of treatment you are doing, a second sample of sperm is placed in the cervix. Some women may experience mild cramping, therefore you may take Tylenol one hour prior to the procedure. Due to the small chance of infection (<1 percent), you will take the antibiotic called doxycycline as directed. You may experience some spotting or light bleeding after the insemination, which is normal; however, we do ask that you avoid any strenuous exercise on the day of your insemination.
Clomid and FSH IUI
Clomid IUI and follicle stimulating hormone (FSH) IUI are techniques that require the use of fertility drugs. Clomiphene citrate, human menopausal gonadotropins (Repronex and Menopur), or purified human FSH (Gonal-F, Follistim, or Bravelle) have been used to induce a condition of superovulation. When these drugs are prescribed, the expected result is an increase in the number of ovulated eggs per cycle, thus increasing the likelihood of fertilization. Fertility drugs also may increase the efficiency of folliculogenesis and may improve subtle luteal phase insufficiencies.
Benefits and Success Rates of IUI
The success rates of superovulation (from hormone treatment) with IUI are between 5 and 20 percent per cycle (depending on the woman's age and egg quality) provided that the male partner's sperm count is within normal limits and the female's tubes are healthy.
The use of hMG or FSH either alone or in combination with intrauterine insemination has been shown to significantly increase cycle fecundity. Overall, the best results are seen when these drugs are used together with IUI.
Doctors might try three cycles of IUI, and if these are not successful, recommend more advanced methods such as in vitro fertilization (IVF). Unlike IVF, IUI does not involve egg collection or IV sedation.