A Guide to Intrauterine Insemination (IUI)

 

For many couples, the journey to a healthy pregnancy is not an easy one. When you’re facing infertility, every month is a roller coaster of hopes and potential disappointment. Fortunately, there are options that can help many couples achieve the healthy pregnancy they’ve been dreaming of. If you’re planning treatment for infertility, intrauterine insemination may be one of the methods introduced by your doctor.

What Is Intrauterine Insemination?

Intrauterine insemination (IUI), is sometimes referred to as artificial insemination. It is a procedure that introduces prepared sperm directly into the uterine cavity through the cervix with the use of a syringe and attached catheter. Fertility clinics can provide artificial insemination in a natural or a medicated cycle using fresh sperm from the male partner or anonymous donor sperm acquired from a sperm bank.

There are many reasons a couple may choose IUI, including:

  • Certain health issues in women that make conception more difficult, including cervical stenosis and poor cervical mucus.
  • Health issues in the male partner that make conception more difficult, including Mild Male Factor (thick semen)
  • Infertility with no known cause
  • Same gender couples or single women wishing to build a family (with the use of donor sperm)

How IUI Works

Intrauterine insemination can improve the chance of fertilization in two ways; by shortening the distance sperm have to swim to meet the egg and by increasing sperm survivability. Preparing sperm and placing it directly into the uterus allows the sperm to survive for 3-4 days in comparison to about an hour in the vagina.

A successful IUI cycle begins with some preparation. For the best chance of a successful pregnancy, it is recommended that both partners undergo diagnostic evaluation before treatment. Male evaluation usually includes a semen analysis while female evaluation includes a thorough medical history and physical exam, followed by diagnostic imaging to check the tubes and ovaries.

Sperm Washing

After sperm is collected it is prepared for the IUI procedure in a process called sperm washing. Ejaculated sperm are usually a mixture of fast and slow moving sperm. Some sperm are able to move forward and efficiently while others can only wobble, move in circles, or not move at all.
Nonmoving sperm can clump together to form a ‘sperm trap’ that can attract motile (active) sperm and impair their ability to get into the uterus. Sperm washing for IUI recovers sperm that actively swim forward to ensure smooth traffic toward the egg.

IUI pregnancy rates are optimal when at least 3 million motile sperm are available for insemination after semen processing. Fresh semen is first washed and spun in a test tube to allow the most active sperm to swim through a layer of filtering media. The resulting pellet at the bottom of the tube that contains mainly motile sperm is then re-suspended in a special fluid to invigorate the sperm and make them ready for intrauterine insemination.

Treatment Options for IUI

IUI treatment can be accomplished with a natural cycle or assisted with medication. While medication generally increases success rates, it can be significantly more expensive. For certain patients, natural cycle IUI is very effective. Several factors are considered when determining which type of treatment is best for you.

Natural Cycle

If you are under 35 years old, and have a normal cycle between 28-32 days, natural cycle IUI can work well. This process works with the assistance of a home ovulation kit. Starting on day 10 of a normal cycle, the ovulation kit is used to detect a surge of Luteinizing Hormone (LH). When a positive surge is detected by the test, you will schedule the IUI treatment with your clinic for the following day.

Medicated Cycle

Certain medications can be used to improve pregnancy success. Medicated cycles are typically recommended for women 35 or older and those who have a cycle longer than 32 days. A medicated IUI cycle begins with the use of oral medications such as Clomid or Femara for 5 days early in the cycle to improve follicular growth and ensure timely ovulation. Additional injectable medications may be used before the procedure. In medicated IUI cycles, sonograms are required to monitor growth of the follicles. At the appropriate time, an injection of HCG is used to ensure ovulation, and artificial insemination is usually performed 24-36 hours after the ovulation trigger.

 

Pregnancy Rates of IUI

The biggest question for couples considering IUI usually concerns how well the procedure works. That’s completely understandable. However, it’s impossible to provide a one-size-fits-all answer. Success with IUI depends on many factors including the woman’s age and the severity of sperm abnormalities.

Many studies have found that the average live birth rate from donor sperm IUI is about 15% per attempt, varying from 10% per cycle with one dominant follicle to 20% with 2-3 dominant follicles. However, it’s important to remember that many women attempt more than one cycle which significantly increases potential pregnancy rates. In fact, in uncomplicated cases, the pregnancy rate jumps to 50-60% with five IUI attempts.

Potential Limitations

While IUI treatment cycles result in a healthy pregnancy for many couples, there are certain conditions that might limit your success. When IUI isn’t an option, couples often consider in-vitro fertilization (IVF). IUI treatment would not be effective in the following situations.

  • Very low sperm count and motility
  • Severely abnormal sperm morphology (shape)
  • Tubal occlusion and pelvic adhesions (or scar tissue that blocks the fallopian tubes)
  • Severe Endometriosis

Cost of IUI

One of the main attractions of IUI is the cost in comparison with more expensive treatments. The cost of IUI cycle is much less than that of an IVF cycle and can vary depending on whether other treatments are also required. The biggest factors in how much IUI treatment costs are the price of an individual cycle at your chosen clinic and whether you require the assistance of medications. It’s important to note that the use of donor sperm will also increase the cost. IVFMD provides

The least expensive IUI treatment involves a natural cycle with no sonograms or medication. While the costs can increase quickly with multiple sonograms and the use of medications, your clinician’s experience and skill can help. Through careful use of medications and monitoring, IUI success can be achieved without making the cost for an IUI cycle overly expensive.

The cost of IUI cycles at IVFMD can be found here.

If you’re struggling with infertility or other factors standing in the way of your healthy pregnancy, you don’t have to face the journey alone. Discussing your unique situation with a medical team is the best way to learn about your options. For more information about IUI treatment or other fertility treatments, get in touch with our friendly staff today. We’re happy to answer your questions.