Intrauterine Insemination (IUI)

What is Intrauterine Insemination?

Intrauterine insemination (IUI) is an office-based fertility treatment. It involves the placement of washed sperm into a woman’s uterus. The timing is important. Insemination must be performed at or before the time of ovulation. The concept of IUI is quite simple. It is a procedure in which sperm cells are placed inside the uterus. In this case, the sperm cells are closer to the egg, and the likelihood of conception can increase. 

When should IUI be used?

The clinical use of IUI is primarily utilized in cases of mild male factor infertility and in some cases of unexplained infertility. IUI is also used in cases of ovulation induction which involves the use of medications that trigger the release of an egg from its follicle. Another important indication is when cervical factors impede pregnancy. In this case, the insemination procedure simply traverses the cervix and overcomes deficiencies in cervical secretion or cervical anatomy.

What is the procedure for IUI?

The timing is very important. The future mother must monitor her menstrual cycle to make sure the date of ovulation can be determined. The most common way is to use an ovulation prediction kit. With this methodology, a urine sample is applied to a reagent strip that returns color on the day of the LH surge. The LH surge will precede ovulation by 24 to 35 hours. The ovulation prediction strip requires a morning urine sample. It measures the increase in LH which precedes ovulation. This is the so-called LH surge. 

A more precise way of confirming the development of a mature egg and follicle is the use of an ultrasound probe through the vagina. Ultrasound imaging allows us to precisely visualize the developing follicle, which contains an egg. Once the critical size of the follicle is reached, we can trigger ovulation ourselves using a shot of hCG. This results in ovulation occurring 24 to 35 hours later. We can also use blood tests to determine a critical time prior to ovulation. Checking cervical mucus can help with the timing of ovulation. The mucus should be profuse and watery.

The male partner also has a responsibility. He must masturbate to produce sperm sample. Is performed on the day of the insemination. The laboratory will form a semen analysis looking at the sperm count and motility. Oftentimes morphology is omitted. The sample is washed so that the sperm cells are concentrated. That sperm and debris are separated out. After the laboratory processing the sperm sample is tested again for counts and motility.

The sperm processing involves spinning the sample and rapid centrifuge. The seminal fluid which is above the sperm cells of the bottom, is drawn off. The rest of the fluid elements of semen are removed by this process. The insemination must use washed sperm not a plain semen sample. The placement of semen can be associated with side effects because the mother’s uterus can react to the foreign proteins of a semen sample.

How is the IUI procedure performed?

Artificial insemination with washed sperm is done in the office. The procedure takes five minutes. The sperm cells are drawn up into a syringe which has a thin flexible catheter attached to it. A speculum is placed in the vagina and the cervix is visualized. The thin plastic catheter is gently applied to the cervix and slip directly into the woman’s cervix. I placed the sample about 1 cm from the top of the uterus. Is painless and simple.

I recommend that my patient rest for 15 minutes. In many cases I provide a prescription for progesterone which is given vaginally to support and build the lining of the uterus. Prior to the procedure I give the patient a dose of doxycycline 100 mg, although this is not always mandated.

How does IUI compare with IVF?

IUI is successful in conditions which are most commonly amenable in cases in which washed sperm is able to increase the likelihood of fertilization. Basically, the outcome depends on the underlying cause of infertility and the age of the recipient. In general, IUI works best cases of infertility which are not severe. Age is a factor for successful outcomes. In particular the number of eggs in the quality of eggs is a key factor in achieving pregnancy.

Profound deficiencies in the sperm sample are usually less amenable to IUI. I like to see a total motile count of at least 10 million sperm cells. Of course, pregnancies can occur even with much lower sperm counts, since only one sperm cell is needed to fertilize the egg This is the total number of sperm cells that are moving the entire sample. Ideally, I would like to see about 15% of the sperm in the wash sample to be motile If over 37, I don’t recommend more than three times using IUI, with or without mild stimulation of the ovaries.

IVF is extremely successful. A woman may produce many eggs all of which are fertilized to produce embryos. Genetically normal embryos are associated with a very high pregnancy rate. In fact, the pregnancy rate with a genetically normal embryo can exceed 50% per cycle. Remarkably this is with the use of just a single embryo. With IVF each egg is injected with a single sperm cell. This process is called intracytoplasmic sperm injection, or ICSI. At the Fertility and Lifespan Medical Institute, Dr. Brody can optimize this procedure and help you build your family.

Call 858-216-2096, or go online, and schedule an appointment with Dr. Brody. Contact us if you have any further questions.