Intrauterine Insemination (IUI)
Intrauterine insemination (IUI) is the most common form of artificial insemination, which involves the placement of sperm into a woman’s vagina, cervix or uterus by means other than intercourse. The second most common form of artificial insemination is intracervical insemination (ICI).
For many women, artificial insemination therapy alone is not adequate. Artificial insemination is usually performed in conjunction with fertility medications such as clomiphene or gonadotropins to further enhance fertility.
To have either procedure performed, a woman must have open fallopian tubes. Women with blocked tubes are not candidates for IUI or ICI.
Intrauterine insemination (IUI)
IUI is a procedure performed in the physician’s office that places sperm directly into the uterus. First, sperm is obtained from the male partner or donor. The sperm is then counted, washed, concentrated and placed into a small syringe.
A small tube (catheter) is attached to the syringe. The catheter is then placed through the cervix and into the lower part of the uterus. The sperm is deposited directly into the uterus.
The advantage of IUI is that sperm become more active when they are washed, so many more sperm reach the egg than in routine intercourse. Since IUI bypasses the cervix, it can help overcome the effects of antisperm antibodies or thick cervical mucus.
Intracervical insemination (ICI)
With ICI, the man’s ejaculate (sperm and semen) is placed into a small flexible rubber cup, which is inserted into the vagina.
ICI does not deliver as much sperm to the egg as does IUI. Sperm used in ICI does not require as much preparation and this procedure can often be performed in the privacy of a patient’s own home. The downside to ICI is that pregnancy rates are lower than with IUI.
Which procedure should I choose?
Most women will choose IUI because pregnancy rates are higher. IUI is a good treatment for couples with unexplained infertility (when used with medications to improve ovulation), and for males with slightly low sperm counts or motility.
ICI is most appropriate for couples who cannot have intercourse due to physical incompatibility and for women who do not have a male partner.
How long does IUI take?
After the man provides a semen sample, it takes about one hour to process the sperm. On rare occasion, sperm processing takes longer, depending on the man’s sperm. Processing frozen or donor sperm takes about 45 minutes.
The IUI procedure takes only a few minutes. We ask you to lie still for about 10 minutes after the procedure. Overall, the process usually takes an hour and a half. If necessary, the male partner and female partner can arrive and depart at separate times.
How likely am I to get pregnant with IUI?
The absolute success rate depends on your age, the conditions contributing to infertility, what medicines you are taking to enhance your fertility (e.g. clomiphene or gonadotropins) and the sperm count in the specimen.
In general, IUI doubles the pregnancy rates seen obtained with intercourse (though these rates vary depending on the cause of the infertility). Couples who have multiple reasons for not being pregnant are less likely to achieve a pregnancy.
Based on your history, your physician will estimate your possible success rates with IUI.
How many times should I do IUI?
We typically recommend three IUIs before regrouping with your physician. After each IUI, your physician will review your chart to see if any changes in medication or treatment plan should be considered.
Women who have not conceived after six IUIs are much less likely to succeed with further attempts with IUI.
What tests do I need?
The following tests are required for IUI:
- Cervical cultures for chlamydia and gonorrhea
- Normal Pap smear in the past year
- Hepatitis B, C, HIV, syphilis (RPR) and cytomegalovirus (CMV) testing
- Blood type and screen
- Men providing a semen specimen for IUI must be tested for infectious diseases: HIV, syphilis, hepatitis B and C, and CMV
How do I know this is my partner’s sperm?
This is a common question among patients, even if they don’t ask out loud. When you arrive in clinic, an IUI order form is generated with your name on it, as well as a numbered code. This order form is given to the lab and a specimen cup is labeled with your numbered code.
After your partner returns the sample, it is transferred into a syringe labeled with your name, your partner’s name and your code. You must identify all three as correct prior to having the IUI performed.
How do I know this is the correct donor’s sperm?
As with correctly identifying a partner’s sperm above, we will label your sperm sample with your name and your code. You must identify both correctly prior to having the IUI performed.
What are the risks of IUI?
IUI complications are rare. Mild cramping is not uncommon during the procedure but this usually resolves within 15-20 minutes. The risk of infection is extremely small. Less than one percent of women ever have a significant problem after IUI.
Call your physician if you develop severe abdominal or pelvic pain, fever or chills within three days after this procedure.
How do I schedule IUI or ICI?
If you are attempting a natural cycle (spontaneous ovulation without medications) or using oral ovulation medications, there are two ways to schedule IUI/ICI:
Using ovulation predictor kits (OPKs). This is mainly used with clomiphene or other oral ovulation induction agents. Call your physician the day your kit turns positive. Since most women ovulate 12-36 hours later, the IUI/ICI is scheduled the next day.
Using hCG injections. HCG will induce ovulation in women who have mature egg follicles. The IUI/ICI will be scheduled approximately 36 hours after the hCG injection, when ovulation occurs.
For women who can reliably detect their own ovulation, studies have shown that the two timing strategies are equally effective. The advantage of using OPKs is lower cost; the disadvantage is that the tests are imperfect and may not always detect ovulation, causing frustration and delayed treatment.
How much does IUI/ICI cost?
Sperm preparation and IUI typically cost around $530. Using hCG requires 1-2 ultrasounds, plus the cost of the injection. Use of donor sperm involves additional costs of purchasing and shipping the sperm from a sperm bank to TRM.
In some cases, a complex sperm preparation is needed to isolate more viable (living), motile (swimming) sperm. This can add a small fee to the cost of the IUI preparation.
The service must be paid for prior to the procedure.