The IUI procedure: 1 of 5 things you should know about an IUI
A Complete Guide to Understanding IUI (intrauterine insemination) and artificial insemination
(Dr Eric Daiter, Board Certified in Reproductive Endocrinology and Infertility)
- The IUI procedure
- Who should consider an IUI?
- IUI success rates
- IUI cost
- What to consider if IUI is unsuccessful
Who should consider an IUI?
IUI (intrauterine insemination) can increase pregnancy rates for many infertile couples.
At our office, when a couple is having difficulty conceiving, I generally suggest a basic diagnostic infertility evaluation to attempt to identify abnormalities. This entry level evaluation normally includes tests related to ovulation (a complete menstrual history, a complete medical history, and blood work for hormone imbalances that might affect ovulation), male factors (a complete medical history, a complete reproductive history, and a semen analysis), and pelvic factors (a hysterosalpingogram, or HSG, to assess the uterine cavity and patency of the fallopian tubes and a postcoital test to assess the interaction of the sperm and the cervical mucus). Based on these results, IUI may be suggested, possibly along with other treatments.
1: IUI often improves pregnancy rates when performed after ovulation induction with medication.
When a woman has an adequate number of eggs within her ovaries and fertility is desired but she is anovulatory (she does not make mature eggs) or oligo-ovulatory (she matures much fewer eggs per year than normal), an oral medication containing clomiphene citrate (Clomid, Serophene) is often used for ovulation induction. When this medication is used, the cervical mucus that is normally abundant and friendly to sperm just prior to the time of ovulation often becomes “hostile” to sperm. Hostile cervical mucus shortens sperm survival within the female reproductive tract and can prevent the sperm from passing through the mucus to reach the egg (within the fallopian tube). In ovulation induction cycles using clomiphene citrate, IUI is often useful in delivering sperm above the cervical mucus and closer to the fallopian tubes at ovulation.
When clomiphene citrate fails to induce ovulation in an anovulatory woman, injectable medications (gonadotropins or menotropins) have a very high success rate (greater than 90%) for ovulation induction. Injectable medications are very expensive compared to clomiphene citrate and they have some additional complications. Research shows that when these injectable medications are used for ovulation induction, IUI increases success rates for pregnancy.
2: IUI can improve success rates for pregnancy if there is a male factor.
Sperm is deposited into the vaginal vault during intercourse and the ejaculate normally contains greater than 40 million sperm. The vaginal vault is characteristically acidic in nature and sperm can only survive in this environment for a short time (less than an hour). In order to fertilize the egg within the fallopian tube around the time of ovulation, motile (moving) sperm normally live comfortably in the slightly alkaline mucus of the cervix for 2-4 days (or longer) and migrate through the uterine cavity to the fallopian tube. Of the greater than 40 million sperm released into the vaginal vault at intercourse, less than 1 million sperm normally make it into the cervical mucus and only a few thousand sperm usually make it up to the fallopian tubes.
IUI with washed sperm generally delivers greater than 1 million sperm directly within the uterine cavity next to the fallopian tubes. Therefore, IUI often improves the ability of sperm to reach the fallopian tubes, where fertilization of the egg can take place, when compared to intercourse.
When an apparent male factor is discovered on semen analysis, fertility treatment options include IUI (ideal for mild to moderate reductions in sperm quality but will occasionally also be successful for severe abnormalities), assisted fertilization requiring IVF (in vitro fertilization) and ICSI (intracytoplasmic sperm injection), and the use of donor sperm (when there is a complete absence of sperm or for severe abnormalities when IVF and ICSI are not available options).
IVF with ICSI is generally very expensive, involves about 2-3 weeks of frequent (sometimes daily) monitoring with blood work and ultrasound exams, and can be highly stressful. On the other hand, IVF with ICSI is usually more successful (in terms of pregnancy rate per cycle of treatment) than IUI.
The use of donor sperm usually involves IUI for placement into the female reproductive tract and requires that the couple carefully consider whether they are comfortable with the use of sperm from a genetically unrelated anonymous male.
3: IUI can improve pregnancy success rates if there is hostile cervical mucus (including anti sperm antibodies).
For normal fertility, sperm must be able to survive comfortably for a couple of days within the cervical mucus. I often suggest a postcoital test (to assess sperm-mucus interaction) just prior to ovulation (when the mucus is friendliest to sperm).
The cervical mucus can become abnormally acidic and this change in pH can severely limit sperm survival. If there is a problem with sperm survival in the mucus then I suggest IUI to place the sperm above the mucus at ovulation. Also, if I find the sperm moving in place (only moving back and forth), as if caught on something within the mucus (usually thought to be due to anti sperm antibodies that attach the sperm to the mucus), then I suggest IUI since these sperm cannot migrate through the uterus to reach the egg in the fallopian tube.
Actual video of human sperm is available for viewing if you decide to download the Guide. Some viewers may find the videos overly graphic while most viewers find them informative and interesting.
(Sperm moving in place with very little forward progression, a characteristic of sperm with anti sperm antibodies attached to them. . Double click on lower left icon to play video)
4: IUI can deliver the sperm into the uterus at ovulation when intercourse is not possible.
For a variety of reasons, intercourse may not be possible and sperm cannot be delivered into the female reproductive tract. If this cannot be remedied, then IUI can deliver the sperm into the uterus at ovulation.
5: IUI can be tried for a few cycles to see if a pregnancy results in couples that do not want to undergo diagnostic testing right away.
Sometimes a couple wants to consider a few cycles of IUI as a low risk and low cost infertility procedure that might improve success rates, prior to any formal diagnostic testing. Couples with no medical insurance often consider this since the out of pocket cost of testing can be significant. In these situations, I discuss the risks and potential benefits of IUI with and without prior diagnostic testing, and if the couple still wants to proceed with a few IUIs without testing then I generally comply.
If you like what you have been reading then download your entire free copy of “The Complete Guide to Understanding IUI,” including actual videos of human sperm samples (showing improvement in the movement of the same sperm before and after the wash and a video of sperm moving in place, taken by Dr. Daiter (warning: some consider these photos graphic or gross).
A video testimonial that expert treatment of infertility can truly accomplish remarkable results!
These brave “real life” stories present examples of the kind of care that Dr. Daiter provides for his patients.