What is IUI? Intrauterine insemination is also called IUI or artificial insemination.
The IUI procedure can be effective treatment for some causes of infertility in women under age 41. It is not effective for couples with:
- Tubal blockage or severe tubal damage
- Ovarian failure (menopause)
- Severe male factor infertility
- Severe endometriosis
Artificial insemination should not be used in women with blocked fallopian tubes. The tubes are often checked out with an x- ray test called a hysterosalpingogram.
Female age is a significant factor with IUI
Intrauterine insemination has very little chance of working in women over 40 years old. IUI has also been shown to have a reduced success rate in younger women with a significantly elevated day 3 FSH level, or other indications of significantly reduced ovarian reserve.
If the sperm count , motility and morphology scores are quite low, Intrauterine Insemination is unlikely to work.
- With significant male factor issues, IVF with ICSI is indicated and has high success rates
IUI is commonly used for unexplained infertility. It is also used for couples affected by mild endometriosis, problems with ovulation, mild male factor infertility and cervical factor infertility.
Insemination is a reasonable Initial treatment that should be utilized for a maximum of about 3 months in women who are ovulating (releasing eggs) on their own. It is reasonable to try IUI for longer in women with polycystic ovaries (PCOS) and lack of ovulation that have been given drugs to ovulate.
How is Insemination performed? What Is the process for artificial insemination in humans?
- The women usually is given medications to stimulate development of multiple eggs and insemination is timed to coincide with ovulation- release of the eggs.
- A semen specimen is either produced at home or in the office by masturbation after 2-5 days of abstinence from ejaculation.
- The semen is “washed” in the laboratory (called sperm processing or sperm washing). The sperm is separated from the other components of the semen and concentrated in a small volume. Various media and techniques can be used for washing and separation. Sperm processing takes about 30-60 minutes.
- A speculum is places in the vagina and the cervical area is gently cleaned.
- The washed specimen of highly motile sperm is placed in the uterine cavity (IntrauterineInsemination, IUI) using a sterile, flexible catheter.
Success rates for IUI
For a couple with unexplained infertility, female age under 35, trying for 2 years, and normal sperm - we would generally expect about:
- 10% chance per month of getting pregnant and having a baby with artificial insemination and Clomid for up to 3 cycles (lower success after 3 attempts)
- 15% chance per month of getting pregnant and having a baby with injectable FSH medication and IUI for up to 3 cycles.
Chances for success in women over 35 drop off, and for women over 40 they are much lower. For this reason, we are more aggressive in older women.
How many inseminations to try before doing IVF?
- The short answer is to move on to IVF after 3 failed IUIs
- If the female is age 40 or older, or ovarian reserve low, consider IVF earlier
- In vitro fertilization has a significantly higher success rate as compared to IUI
How important is timing of the IUI?
Any insemination should be carefully timed to occur at or a little before the time of ovulation. We know that in some couples, sperm can remain viable in the female reproductive tract and result in fertilization of an egg for five days (after having sex).
Eggs are fertilizable for only about 12-24 hours (maximum) after ovulation. Therefore, IUIs must be properly timed so that sperm show up for the date while the eggs are still viable.