What is intrauterine insemination?
Intrauterine insemination is also known as artificial insemination or IUI. Human artificial insemination with the male partner's sperm for infertility began being used in the 1940s. The IUI procedure can be an effective treatment for some causes of infertility in women under about age 41.
When is IUI used?
IUI is most commonly used for unexplained infertility but can also be performed in the following circumstances:
- Mild endometriosis
- Problems with ovulation
- Mild male factor infertility
- Cervical factor infertility
However, IUI is not effective for couples with:
- Tubal blockage or severe tubal damage
- Ovarian failure (menopause)
- Severe male factor infertility
- Advanced stages of endometriosis
Artificial insemination should not be used in women with blocked fallopian tubes.
Female age and a reduced ovarian reserve are a significant factor with IUI and intrauterine insemination has a lesser chance of working in:
- Women over 40
- Significantly elevated day 3 FSH level
- Significantly reduced ovarian reserve
If the sperm count, motility and morphology scores are low, intrauterine insemination is unlikely to work (see the table with male factor IUI success rates at the bottom of this page). With significant male factor issues, IVF with ICSI is indicated and has a higher success rate for women under age 40.
Insemination is a reasonable initial treatment that should be utilized for a maximum of 3-4 months in women who are ovulating on their own. It is reasonable to try IUI for longer than this in women with polycystic ovaries (PCOS) and those who have trouble ovulating and have been given drugs to ovulate.
How does the IUI procedure take place?
- The woman usually is given medications to stimulate the development of multiple eggs and the insemination is timed to coincide with ovulation.
- A semen specimen is either produced at home or in the office by masturbation after 2-5 days of abstinence from ejaculation.
- The semen is "washed" in the laboratory (called sperm processing or sperm washing). The sperm is separated from the other components of the semen and concentrated in a small volume. Various media and techniques can be used for the washing and separation. Sperm processing takes about 30-60 minutes.
- A speculum is placed in the vagina and the cervical area is gently cleaned.
- The washed specimen of highly motile sperm is placed either in the cervix (intracervical insemination, ICI) or higher in the uterine cavity (intrauterine insemination, IUI) using a sterile, flexible catheter.
The intrauterine insemination procedure, if done properly, is associated with little or no discomfort. Most clinics let you remain laying down for a few minutes after the procedure, although it has not been shown to improve success rates. The sperm has been put above the vagina and cervix, so it will not leak out when you stand up.