Intrauterine Insemination (IUI)
Intrauterine Insemination (IUI) bypasses several potential cervical problems that have suggested associations with infertility:
By bypassing the cervix, IUI increases the number of sperm in the uterus, and hence the chance of sufficient sperm reaching the fallopian tubes where fertilization takes place. (Care must be taken not to allow too many sperm to reach the site of fertilization or abnormal fertilization could result if two sperm were to fertilize an egg at the same time).
In addition to IUI, Controlled Ovarian Hyperstimulation (COH) is also often consider for couples who have been trying to have a baby for at least a year and whose infertility has no known cause (“unexplained” or “idiopathic” infertility).
For older women this treatment may be considered sooner.
Under normal circumstances IUI uses sperm from the woman’s male partner. If she does not have a partner, or if her partner has very poor quality sperm, then insemination using sperm from screened, anonymous donors could be considered (see separate brochure on Donor Insemination for more information).
The success rate from IUI can be increased when combined with medications to enhance ovulation. There are several medications available, some of which are taken orally while others need to be given by injection. The costs of these drugs, success rates and side-effects are very variable.
IUI is not appropriate for you if the woman has blocked tubes on both sides or possibly in some cases if the man has a very low sperm count or poor SFA result-see below under Male Partner work up
In addition factors such as age and the desired family size should be taken into account in choosing between IVF and IUI.
IUI is a generally slower and less efficient means of achieving a pregnancy in the shortest time.
Male Partner Work-up
If you are considering a simpler approach such as IUI you should be aware that IUI has limited success where the man has a very low sperm count or poor sperm quality. Therefore, before proceeding with treatment, sperm tests should show a reasonable expectation of adequate sperm function.
To further characterize the sperm we optimize assessment with a detailed assessment of sperm parameters called a Sperm Functional Assessment (“SFA
Female Partner Work-up
Basic infertility tests should be done to confirm regular ovulation, a normal uterine cavity and patent fallopian tubes before commencing IUI treatment.
- if the female partner’s medical history and clinical examination suggest possible pelvic pathology, then a hysterosalpingogram and/or a laparoscopy might be recommended before starting treatment.
Frequently Asked Questions
The success rates that can be achieved using IUI depend on several factors, in particular:
- female age;
- semen quality and quantity;
- ruling out factors not suitable for IUI such as blocked tubes and/or other pelvic factors (as mentioned, sometimes after a brief trial of IUI first);
- correction of problems with ovulation;
- for unselected cases there is a 9-10% success rate
Infection from the insemination itself (very rare).
The day after an LH surge occurring naturally or “triggered” by a hormone injection, the male partner will need to produce a semen sample by masturbation into a sterile container. It is best if the sample is produced at GFRM where we have allocated room for this purpose. The sperm will then be washed and concentrated, a process which takes about 1½ hours.
Using a fine catheter, the washed sperm are introduced through the cervix into the uterus. Usually the insemination is fairly painless, although on occasion there might be some mild to moderate discomfort. Afterwards you should lie quietly for 5 to 10 minutes before resuming your normal activities.
Although excessive exercise or swimming will be discouraged for a couple of days, do not worry, the sperm can’t fall out! A pregnancy test is done 14 days after the insemination. If the test is positive, an ultrasound will be arranged about 4-5 weeks after the insemination.
Please refer to the current GFRM price list for the fees for IUI treatment cycles. These fees depend on the type of cycle (e.g. with or without COH) and include the following elements cycle management, monitoring (but not the ovulation predictor kits), the trigger, sperm preparation and insemination. Medications are extra as their cost varies widely between patients.
Ovulation Predictor Kits: Depending on where you buy them, the price can vary between $35 and $50 for a 5-test kit.