Artificial insemination is the process whereby processed sperm are directly injected into the uterus. It is commonly referred to as IUI or intrauterine insemination. Important considerations about IUI are:
Why can it be helpful?
- First, the IUI makes the trip shorter for the sperm to meet the egg within the female tract. Second, it gets around any losses of sperm that can occur after intercourse and avoids contact with vaginal secretions that are normally acidic in nature and can harm sperm. Third, it may bypass a hostile cervical mucus sometimes seen in patients (secondary to inflammation or hormonal issues).
How is it done?
- After collection, sperm are immediately processed in the lab. Sperm are ejaculated as a mixture of cells and fluid called the semen. Semen per se cannot be injected into the uterus because it can cause pain or infection. The laboratory will process the collected sample to become IUI-ready in one of two ways: 1) wash and centrifugation or 2) gradient separation. By the end of these procedures the sperm are resuspended in culture medium (that has antibiotics), typically in a volume of 250-500 microliters and are ready to be deposited into the uterine cavity with a flexible catheter, in what should be a painless office procedure that takes place in a few minutes. We recommend 10-minute rest after the IUI and then patients can go on with their routine.
Is it safe?
- An adequate processing of the semen sample is critical to avoid infection and to maximize the yield of motile sperm for each IUI. It follows that the laboratory doing the IUI has to be certified and has a validated internal quality assurance program, that is monitored by national licensing organizations.
Who can benefit from IUI?
- We recommend this method first as a treatment for infertility in a few scenarios. The procedure can be used for many kinds of fertility problems, but nor for all. Higher chances of success are seen in cases of: a cervical factor (poor mucus), mild to moderate male factor (mild anomalies in terms of sperm count or motility), or cases with unexplained infertility. Open tubes are a must and should be documented by an HSG. More severe male factors, endometriosis and of course tubal pathology and pelvic adhesions will not benefit from IUI therapy and are better managed by IVF.
How does the IUI cycle work?
- We monitor the cycle by ovulation kits, ultrasound, or blood tests to make sure you are ovulating and to determine the optimal timing of the IUI. Then, your partner will need to provide a sample of his semen. We recommend that your partner avoid sex for 2 to 4 days before the procedure to try to maximize the sperm count.
Is a natural cycle better than using ovulation stimulation drugs?
- This depends on the circumstances. We will prescribe these medications (i.e., clomid -an anti-estrogen- or letrozole -an aromatase inhibitor-) when there is irregular ovulation or anovulation, and in cases of unexplained infertility. Pregnancy rates can be higher when combining ovulation stimulation with IUI, but keep in mind that there is a risk of multiple gestations. That is why monitoring response with an ultrasound is mandatory to know the number of follicles developed in each cycle. These medications are safe, but they may have side effects. Cases of polycystic ovarian syndrome may require use of injectable gonadotropins.
What are the success rates of IUI?
- The percent of couples that become pregnant after one cycle of IUI ranges from 5 to 20 percent. However, different factors can affect these success rates, including fertility problems for men and women as well as age. Here are insemination success rates by age: women under 35: 10 to 20 percent chance of getting pregnant during an IUI cycle; women between 35 and 40: 10 percent chance of getting pregnant using IUI when using fertility drugs; and women over 40: 5 percent chance of getting pregnant using IUI with fertility drugs. Based on available evidence we recommend one IUI per cycle, and a total of 3-4 IUI cycles to maximize the so-called cumulative pregnancy rate (after which we should think IVF).
Couples that elect to use donor sperm (from a certified cryobank) follow these recommendations and today donor sperm is always prepared as frozen and IUI-ready. Success rate of IUI with donor sperm can be as high as 60% after trying for 6 months if no female factors are present.
In summary, IUI is a low complexity process, with relatively low cost (sometimes an insurance company will cover a portion of the costs related to IUI), that requires adequate monitoring and a certified laboratory, and offers discrete success rates for some cases of infertility.
Contact Sher Fertility Institute New York at 646-792-7476 or click here to schedule an appointment with one of our fertility doctors. Our Patient Care Specialists will contact you within the next 24 hours.