Intrauterine Insemination (IUI)
OverviewIntrauterine insemination (IUI) is a procedure for treating infertility that helps to improve the sperm quality and performance and deliver it as close as possible to the egg. Sperm are first put through a gradient centrifuge to remove all the cells and debris that can negatively impact their performance. They are then placed into an energy rich fluid that makes many more of the sperm swim and increases their speed. That solution is then injected into the uterus with a very soft catheter in a painless procedure that takes less than two minutes. The timing is optimized to occur as close as possible to the time of your ovulation (sperm in the vagina). The hoped-for outcome of IUI is for the sperm to swim into the fallopian tube and fertilize a waiting egg, resulting in a normal pregnancy. Depending on the reasons for infertility, IUI can be coordinated with your normal egg production or with fertility medications to increase the number of eggs being produced.
Why it's done
A couple's ability to become pregnant depends on many different factors. Intrauterine insemination is used the most common fertility treatment. It can be used for many reasons including: low sperm counts, low sperm motility, low sperm speed, or very high viscous sperm samples. Additionally, it can be beneficial in women with cervical narrowing (stenosis), unexplained infertility, endometriosis, Polycystic ovary syndrome (PCOS) or oligo-ovulation.
Cervical factor infertilityYour cervix, at the lower end of the uterus, provides the opening between your vagina and uterus. Mucus produced by the cervix around the time of ovulation provides an ideal environment for sperm to travel from your vagina to the fallopian tubes. But, if your cervical mucus is too thick, it may impede the sperm's journey. IUI bypasses the cervix, depositing sperm directly into your uterus and increasing the number of sperm available to meet the awaiting egg.
Unexplained infertilityIUI is often performed as a first treatment for unexplained infertility along with ovulation-inducing medications.
Endometriosis-related infertilityFor infertility related to endometriosis, using medications to obtain a good quality egg along with performing IUI is often the first treatment approach.
Mild male factorYour partner's semen analysis, one of the first steps in the medical assessment of infertility, may show below-average sperm concentration, weak movement (motility) of sperm, or abnormalities in sperm size and shape (morphology). IUI can overcome some of these problems because preparing sperm for the procedure helps separate highly mobile, normal sperm from those of lower quality. Semen allergy in another factor. Rarely, a woman could have an allergy to proteins in her partner's semen. Ejaculation into the vagina causes redness, burning and swelling where the semen contacts the skin. A condom can protect you from the symptoms, but it also prevents pregnancy. If your sensitivity is severe, IUI can be effective, since many of the semen proteins are removed before the sperm is inserted. For women who need to use donor sperm to get pregnant, IUI is most commonly used to achieve pregnancy. Frozen donor sperm specimens are obtained from certified labs and thawed before the IUI procedure.
How you prepare
Intrauterine insemination involves careful coordination before the actual procedure and has several steps
Step 1Monitoring for ovulation. Because the timing of IUI is crucial, monitoring for signs of impending ovulation is critical. To do this, you might use an at-home urine ovulation predictor kit that detects when your body produces a surge or release of luteinizing hormone (LH), or, an imaging method that lets your doctor visualize your ovaries and egg growth (transvaginal ultrasound) can be done. You also may be given an injection of human chorionic gonadotropin (HCG) to make you ovulate one or more eggs at the right time.
Step 2Preparing the semen sample. Your partner provides a semen sample at the doctor's office, or a vial of frozen donor sperm can be thawed and prepared. Because non-sperm elements in semen can cause reactions in the woman's body that interfere with fertilization, the sample will be washed in a way that separates the highly active, normal sperm from lower quality sperm and other elements. The likelihood of achieving pregnancy increases by using a small, highly concentrated sample of healthy sperm.
Step 3Injecting the sample. Your doctor or a nurse will have you lie down on a bed and you will be covered with a blanket. A warmed small speculum will be placed in the vagina to allow visualization of the cervix. The cervix then needs to be carefully cleaned with cotton tipped swabs, or a small suction catheter of all mucous to optimize results. The sample is then loaded into a very soft catheter which is painlessly introduced through the cervix and into the body of the uterus. The sample is then deposited at the top of the uterus, close to the fallopian tube openings. The catheter stays there to block any back flow for one minute and then is removed along with the speculum. Most patients will remain lying down for approximately 15-20 minutes. After that we recommend you resume normal activities while avoiding anything too strenuous or stressful.
Wait two weeks before taking an at-home pregnancy test. Testing too soon could produce a result that is either false negative or false positive: False-negative. If pregnancy hormones aren't yet at measurable levels, the test result may be negative when, in fact, you really are pregnant. False-positive. If you're using ovulation-inducing medication such as HCG, the medication that's still circulating in your body could indicate a pregnancy when you really aren't pregnant. Your doctor may instruct you to return about two weeks after your insemination for a blood test, which is more sensitive in detecting pregnancy hormones after fertilization. If you don't become pregnant, you might try IUI again before moving on to other fertility treatments. Often, the same therapy is used for three to six months to maximize chances of pregnancy.
Intrauterine insemination is a relatively simple and safe procedure, and there are virtually never any complications. The main risk is a chance of mild cramping at the time of the procedure, which usually lasts only a few seconds. We use an ultra-soft catheter that minimizes the chances of cramping and/or pain. The cervix must be prepared and cleaned of all mucous which can cause some mild spotting. Very rare additional risks may include multiple pregnancy and ovarian hyperstimulation syndrome which occurs extremely infrequently.