INTRAUTERINE INSEMINATION (IUI)
Intrauterine Insemination (IUI), is a fertility treatment which involves introducing sperm cells into a woman’s womb (uterus) to facilitate fertilization. It is often used for couples with male infertility, unexplained infertility, or women with cervical mucus problems.
WHAT IS IUI AND HOW IT IS PERFORMED?
Intrauterine insemination is an artificial insemination (AI) technique aimed at bringing more motile sperms as near as possible to the fallopian tubes and subsequently increase the possibility of egg fertilization (other AI techniques are intracervical insemination (ICI), intratubal insemination (ITI), and intravaginal insemination (IVI)).
In an IUI treatment, sperm is directly injected into the woman’s uterus, bypassing the cervix. The sperm is washed before being placed into the uterus in order to remove any non-motile sperm and mucus. Sperm washing is intended to increase the chance of pregnancy and sometimes to prevent transmission of certain diseases such as HIV.
IUI is performed in a clinic or private office by a medical practitioner using a catheter. It may use the husband’s sperm or donor sperm. It is performed at the time of ovulation and may be done in conjunction with ovulation induction treatments for women who have ovulation disorders.
Before prescribing an IUI treatment, doctors examine couples to diagnose any problem that has made them unable to conceive a child naturally. These examinations include tests to define sperm quality, its mobility or motility, female reproductive system conditions and organs for the success of ovulation. During an IUI preparation, a physical examination may also be done on the woman’s reproductive system. Also, certain medications may be prescribed, including ovulation drugs, such as gonadotropins, clomiphene citrate, or urofollitropin.
Semen is taken from the male partner, or a third donor (sperm bank). The sperm sample can be used raw or stored and frozen for the proper time to be transferred to the female’s uterus. Timing is critical because it needs to be introduced to woman uterus close to the time that egg is released from the ovary.
If the male partner’s sperm is to be used, the semen collection is done at the same time as the procedure. This usually is done by masturbation, or sometimes through electrical stimulator or special collection condom, which is used during sexual intercourse to capture the sperm. It is recommended that the man abstain from ejaculation for 2-3 days before providing a sample in order for it to have a higher sperm count, and thus increase the success chance.
In cases that the male partner cannot be present at the clinic at the time of IUI treatment to provide freshly ejaculated semen, his sperm can be frozen at an earlier time and be used later. In this case, the sperm is thawed before being placed into the woman’s uterus.
Donated sperm cases also use third-party sperm kept frozen in a sperm bank. Donated sperm should be thawed before being used.
The timing of an IUI treatment is crucial. Generally, the egg can be fertilized within the space of 12 – 24 hours. In order for a successful IUI treatment, the sperm must arrive in the fallopian tube when the egg is present. The best time for an IUI procedure is between 6 hours before and 6 hours after ovulation. If human chorionic gonadotropin (hCG) is used for ovulation induction, the IUI is usually performed 24-36 hours after hCG trigger shot.
Intrauterine insemination is a simple and more cost-effective infertility treatment than other procedures like IVF. It is a viable option for many couples with male factor infertility, female factor infertility or both.
Before considering an IVF, which is a costly procedure, people with the following conditions can try IUI as a first fertility treatment:
Low sperm count and motility in male partners
Male partners with retrograde injection problem
Women with PCOS (Polycystic ovary syndrome). (IUI for PCOS patients has a higher success rate compared with other infertility problems.)
Women with mild to moderate endometriosis
Women with cervical mucus problem
Women with semen allergies
Couples who rarely have sexual intercourse
Generally, the best candidates for IUI are those who have:
Sufficient quality eggs
Adequate hormone levels
Male partner with sufficient sperm count
Fallopian tubes that are in good health and not blocked
Realistic expectations about the outcome of the procedure, because pregnancy is not guaranteed and people may need to undergo more cycles of IUI in the future.
IUI doesn’t work for people with:
Blocked fallopian tubes
Previous pelvic infection
WHAT IS THE SUCCESS RATE OF IUI?
IUI treatment success rate depends on many factors, including the cause of infertility and the quality of sperm and eggs, and age. Also, keep in mind that the success rate of a cycle of IUI is often low, which makes it necessary for most couples to repeat the treatment.
A study of about 1000 IUC cycles has shown that the success rates of intrauterine insemination for couples with different infertility problems who had more than one cycle of IUI were as follows:
55.6 percent for cervical problems
47.4 percent for ovulation problems (anovulation)
41.7 percent for male factor infertility
37.6 percent for low sperm count (oligospermia) (less than 20 million sperm per ml)
35.1 percent for unexplained infertility
13.4 percent for poor sperm motility (asthenospermia)
10.7 percent for endometriosis
WHAT ARE IUI RISKS?
IUI treatment does not pose serious risks. The main risk (if one can call it a risk at all) is multiple pregnancy (twins, triplets, etc.), which is increased if the patient takes gonadotropins, and miscarriage. There is also a small risk of infection after artificial insemination. Other risks are the potential side effects of ovulation induction medications that may be used to increase the success chance in an IUI cycle.
INTRAUTERINE COST: HOW MUCH IS A CYCLE OF IUI?
IUI is a relatively cheap fertility treatment. The cost of a cycle of IUI depends on different factors, such as the country and clinic you want to have the treatment, doctor fee, medications, and whether it is done using the male partner’s sperm of donated sperm.
IUI IN IRAN
Iran is one of the pioneering countries in providing fertility treatments. With more than 70 specialized fertility clinics, Iran has modern facilities and human resources to help couples from infertility problems conceive a child.
IUI is one of the most common fertility treatments in Iran. The success rate of IUI in Iran is as high as that of the best clinics in the world. Iranian fertility specialists are also very experienced and knowledgeable.