Intrauterine insemination (IUI) is one of fertility treatments that includes placing processed sperm cells inside uterus. The main goal is to increase number of motile sperm cells inside the fallopian tubes, thus increase the chanse of fertilization. Ones when the sperm cells reach fallopian tube, where the oocyte is on the way to the uterus, the fertilization happens by its self. Compared to Assisted reproductive technology (ART) where oocytes are handled, only gametes that are processed for intrauterine insemination are sperm cells.
Who are the patients suitable for IUI?
The patients with decreased sperm number or sperm concentration as well as the ones with decreased sperm mobility are usually selected for IUI. In some conditions like unexplained infertility, cervical factor infertility, for instance cervical scar tissue that blocks sperm to enter uterus or unreceptive cervical mucus that prevents sperm from getting into uterus and erectile disfunction.
Who are the patients who are not recommended for IUI?
Women who have dysfunctional fallopian tubes, frequent pelvic infection or moderate to severe endometriosis. Men who produce too low number of motile sperm cells (severe oligozoospermia (less than 5 million motile sperm cells in entire ejaculate), severe asthenozoospermia (less than 20 % motile sperm cells), cryptozoospermia or are diagnosed with azoospermia.
What is the procedure?
Before IUI, the ovaries may be stimulated by clomifene, letrozole, gonadotropins or their combination, to increase the number of follicles or can be performed during a natural ovulation cycle. The follicles are constantly monitored by ultrasound and measured. If the ovaries are not stimulated, IUI takes place 36 hours after the surge in LH hormone. The surge of LH hormone indicates that the ovulation will occure soon. In case that ovaries are stimulated, when follicules reach 17-19 mm, human chorionic gonadotropin (hCG) or gonadotropin releasing hormone (GnRH) agonist is introduced to trigger oocyte maturation. Just before ovulation, 36 hours later, IUI is performed.
Male partner provides a semen sample the day of the procedure. The ejaculate is processed to separate sperm cells from the seminal fluid in the andrology lab. Separated sperm cells are aspirated inside the catheter that will be intraduced inside the uterus through cervix. It is possible to inject washed sperm into the fallopian tube (ITI, Intratubal insemination).
The entire procedure is not invasive, does not cause any pain and cause minimal discomfort. It takes a few minutes, and there is no recovery time at the facility.
What are the main risks?
The risk of multiple pregnancies is present if the ovaries are stimulated. The risk of infections after IUI is minimal. if there is a high risk of multiple pregnancies (more than 2-3 large growing follicles) the procedure will be cancelled in this cycle.
How successful is IUI?
The success rate depends on several factors (the cause of infertility, age, are the ovaries stimulated or not) but the success rate is between 10 up to 20 % per one cycle. Usually IUI is performed 3 to 4 times, depending on the age of the woman.