Intrauterine insemination, or IUI, is the most commonly used method of artificial insemination. Unlike sexual intercourse, the IUI process deposits sperm directly into the female partner’s uterus, bypassing the cervix, which normally blocks a large percentage of sperm from making it to the fallopian tubes. IUI can be used in combination with hormone treatments and ultrasound to encourage and track egg development. These procedures significantly improve the chances of success with IUI. Compared to IVF, IUI is much less involved and has a considerably lower cost. It is most effective in addressing some instances of male-factor infertility and cervical challenges. Some of the requirements for IUI and a description of the IUI process are listed below.
THE IUI PROCESS
There are five main steps involved in IUI:
During the first step, the female partner receives hormone treatments to stimulate the production of eggs in the ovaries. Boosting egg production increases the chances of fertilization when the sperm is introduced. Once the treatment has started, our staff carefully monitors the development of follicles in the ovaries and adjusts the hormone dosage as needed. This monitoring includes blood tests and ultrasound observation, all available at our Santa Barbara fertility center.
Once we have observed sufficient ovarian development from the initial hormone treatments, the female partner will receive a second hormone injection to induce ovulation, releasing the mature eggs into the fallopian tubes. These first three steps allow our staff to closely monitor ovulation so the actual insemination is timed with the greatest chance of fertilization.
The IUI procedure itself involves providing, preparing, and inserting the sperm sample. After the male partner provides a sperm sample (done the same day as the IUI procedure), the sperm is washed and spun in a centrifuge to maximize the percentage of strong, healthy sperm. If the parents have opted for gender selection, the sperm can go through an additional washing process to increase the chance of a specific gender at conception. Once the sample is prepared, it is injected through a small catheter through the cervix into the uterus. This procedure is relatively painless (similar to a Pap smear), can be conducted in our office, and only takes about five minutes.
After the procedure, Dr. Dan will arrange for pregnancy testing and ultrasound monitoring to see if the IUI process was successful. When combined with hormone treatments, the procedure has a success rate of 5%-15% per cycle. After about three unsuccessful cycles, Dr. Dan may recommend more advanced fertility options such as IVF.
REQUIREMENTS FOR IUI
Because the IUI process works by inserting sperm into the uterus to increase access to the fallopian tubes, there are a few requirements for the male and female partner.
Two common instances of male factor infertility are low sperm count and low motility (the percent of sperm that move). IUI helps to address these challenges, as the sperm washing process concentrates the sperm count and selects for healthy, mobile sperm. In addition, by bypassing the cervix, the entire concentrated amount of sperm has a better chance of reaching the egg for fertilization. However, If the male partner’s sperm count is extremely low, or if the morphology (shape of the sperm) is especially abnormal, then IUI may not be an effective treatment option. All of these qualities will be evaluated with a comprehensive sperm analysis during initial testing to determine if the sperm is viable for the IUI process.
For the female partner, the fallopian tubes must be clear and unblocked to attempt IUI. In addition, the female partner should have a normal uterus shape, as uterine abnormalities can prevent the fertilized egg from implanting and developing. Finally, the female partner must be able to ovulate. Even if she has trouble ovulating naturally, if she responds well to fertility medication, then IUI is still an option when combined with hormone treatment to induce ovulation. For all these reasons, IUI is normally recommended only after any clear causes of infertility (blocked fallopian tubes, uterine scarring, etc.) have been ruled out. Our initial testing gathers all the information necessary to create an appropriate fertility diagnosis and decide if IUI is the right choice for you.