Treatments & Success
Intrauterine Insemination (IUI) Treatment
Currently, we have three ways to deliver the sperm to the oocyte (egg): (1) intercourse, (2) artificial insemination (3) in vitro fertilization, where the sperm and egg are put together in the laboratory. Artificial insemination is the process by which the physician places the sperm in the female reproductive tract instead of the male partner. It was first performed in the United States in the late 1800’s though there are suggestions that artificial insemination may have occurred in ancient times as well. There are several types of artificial insemination but at CFS, we use intrauterine insemination (IUI) exclusively because it is more effective and less invasive.
Is IUI Right for You?
Patients who may benefit from intrauterine insemination include those with:
– Unexplained Infertility (when combined with ovulation induction drugs)
– Mild to modest abnormalities with the sperm
– Problems with the cervix
– Problems with intercourse (e.g.: pain with intercourse, significant erectile dysfunction)
– No sperm is available and use sperm from a sperm bank
Getting Started with IUI:
Before treatment can be started, an appropriate infertility evaluation must be completed. This starts with making an appointment to see one of our Physicians or Nurse Practitioners. They will look at the sperm parameters to make sure they are sufficient for the IUI process, make sure the uterine cavity is normal and the fallopian tubes are open, evaluate ovarian function and look for medical issues to be corrected to optimize the process.
How Does IUI Work?
The key to success with IUI is to deliver the sperm at the time when the egg is available and able to be fertilized. The egg can be fertilized for only about 12-24 hours after its release. Sperm are likely to maintain their ability to fertilize an egg for 2-3 days, so it is important to know when the egg is going to be released and then deliver the sperm in advance of the egg’s release.
IUI’s can be done in natural cycles or in cycles where medication is used. Natural cycles are used primarily for individuals using donor sperm or when there are problems with intercourse. Typically, in these cycles, we monitor for ovulation with simple ovulation predictor kits and do the IUI the day after the kit turns positive (egg is released later the same day as IUI).
We use medicines with IUI for Unexplained Infertility as well as a variety of other reasons. In medicated cycles (see Ovulation Induction for details), we are using the medications to get 2-4 eggs available and then deliver the sperm at the correct time. To do this, we use ultrasound and blood work to monitor the follicle development (follicles contain the eggs). The ultrasound tells us how many follicles are developing and about the egg maturity. The blood work (hormones) tells us how active the follicles are. When a safe number of follicles reach the mature size, a “trigger shot” (the hormone hCG) is given to start the ovulation process, which takes 38-40 hours. The IUI is then done some time prior to the egg being released.
On the day of the insemination, the male partner produces a semen specimen (or the donor sperm is thawed) and it is processed to separate the sperm from the semen and concentrate it in a small volume of fluid (culture media). This typically takes about an hour to do. When the specimen is ready, the woman will have a speculum placed in the vagina to visualize the cervix (just like with a pap smear) and then the thin catheter is placed into the cervix and up into the uterine cavity and the sperm are released there. The IUI catheter and speculum are removed, and the woman is free to go about her day with no restrictions. The actual IUI itself takes just a couple of minutes. About 2 weeks after the IUI, a pregnancy test is done.
How Effective is IUI?
The effectiveness of intrauterine insemination in natural and medicated cycles will depend on a variety of conditions. Your doctor will review your specific chances of success with you based on your evaluation. In general, egg quality is the major determinant of success. Egg quality is dependent to a degree on the age of the woman, but also on other factors. Sperm number and quality are also important determinants of success. When frozen sperm is used, it has about a 1/3 lower pregnancy rate than fresh sperm. Pregnancies are extremely uncommon when we have less than 5 million motile sperm for the insemination. The presence and severity of other anatomic abnormalities (Scar tissue in the pelvis, tubal problems, endometriosis) can negatively impact the outcome of intrauterine insemination. A woman’s weight may also influence the outcomes of these treatments. There is good evidence to suggest that a woman with a body mass index (BMI) over 30 kg/m2 has a substantially lower pregnancy rate than the normal weight women.
Side effects and Risks
Artificial insemination in natural cycles is very well tolerated and safe because there are usually no medications used. The medicated cycles are also very well tolerated because for safety reasons, they are mild stimulations. At the time of the insemination, there is the discomfort of the pelvic exam, along with slight cramping that some women feel when the insemination is done. Our biggest risk of IUI’s is multiple pregnancy. The risk of a multiple pregnancy (nearly all twins) is about 10% in medicated cycles. In natural cycles multiple pregnancy risk is the same as spontaneous conception, about 1%. The chance of infection from an IUI is extremely small.
Make an Appointment with us
Here at Coastal Fertility Specialists we have the ability to diagnose and treat many causes of infertility. We will do everything we can to investigate the causes of your fertility problems and help you bring home a baby. Call us at 843-883-5800 for any questions or to schedule an appointment.