IUI is a common infertility treatment generally considered to be a “lower tech” approach than other options. Millions of sperm are placed into the uterus during the time when a woman is most fertile, around the time of ovulation. IUI is often recommended when cervical factors are involved since placing the sperm directly into the uterus bypasses the cervix. Mild to moderate reduction in semen quality is another reason IUI may be considered. It may also be used as treatment for unexplained fertility or for women pursuing donor sperm insemination. Typically, IUI is performed after a woman takes fertility medication, such as an oral medication like clomiphene citrate, or injectable medications.
Although the chance of success varies with the specifics of each patient, IUI yields about a 5-10% pregnancy rate per cycle in couples where the monthly conception rate without treatment might only be 1-3%. (IUI in conjunction with gonadotropin yields a 15-20% success rate.) IUI is generally considered to be a “lower tech” approach to the treatment of infertility because all the critical steps necessary for conception, including the fallopian tube picking up the ovulated egg and the sperm finding and successfully fertilizing the egg, must occur without our interference. With a “high tech” approach such as In Vitro Fertilization (IVF), we are bypassing many potential hurdles in the IVF laboratory. Therefore the success rates in general can be expected to be higher with IVF. For these reasons, if a pregnancy has not been achieved after 3-6 cycles of IUI, we discuss moving towards IVF.
The IUI cycle begins with a baseline ultrasound on cycle day three to ensure there are no ovarian cysts and that the medications can begin. After taking the fertility medications, an ultrasound is performed to evaluate the response of the ovaries and to observe the developing follicle. The IUI procedure is scheduled based on the results of ultrasounds and the urinary LH (luteinizing hormone) testing kit.
The insemination is performed on the day following detection of the LH surge. On that day, the male partner provides a semen sample. The sample is “washed” in a special solution and the dead, immotile sperm are removed. The remaining sperm are concentrated so that a higher concentration of motile sperm can reach the fallopian tube where fertilization occurs. The prepared sperm sample is then placed directly into the uterus through the cervix by means of a thin plastic catheter. The insemination procedure typically takes 5-10 minutes and is not painful.
Side effects are rare but may include cramping. The risk of complications is low and related mainly to the possibility of introducing infection; we typically administer a prophylactic antibiotic at the time of the procedure to prevent infection. The use of fertility medications poses certain risks, such as ovarian hyperstimulation and multiple pregnancy.