Intra-Uterine Insemination (IUI)

What is IUI?

Intrauterine insemination (IUI) is a procedure that involves placing of sperm inside a woman’s uterus to facilitate fertilisation. It usually only requires the insertion of a speculum and then the cannula. This fertility treatment does not involve the manipulation of a woman’s eggs. The goal of IUI is to increas the number of sperm that reach the fallopian tubes and subsequently increases the chances of fertilisation.

Timing of IUI

Timing the IUI is very important – it must be done when the egg is in the fallopian tube.

During an intrauterine insemination, the sperm are released into the uterus. The sperm do not remain viable for a long period of time. Consequently, the sperm must be inseminated close to the time of ovulation.

One of the methods to time an IUI is with an ovulation predictor kit. The kit measures a woman’s LH surge. The surge peaks about 12-24 hours before the egg is released. A woman will test her urine in the morning. If the test is positive, she should have the intrauterine insemination the next day.

Another method for timing an insemination is to artificially trigger ovulation. A medication called hCG (human chorionic gonadotropin) can be injected when ultrasound determines that the egg or eggs developing in her ovaries are mature enough to be released. Ideally, an IUI is performed about 36 hours post hCG injection. The egg is only viable for a maximum of 24 hours after it is released.

Success rates for IUI

The success rate of IUI depends on several factors.

  • Age of the female, ovarian function, fallopian tube blockage, pelvic adhesions and other additional causes of infertility.
  • Amount of motile sperm that are inserted into the uterus. Several studies have indicated that if a man has a lower number of progressively motile sperm after sperm wash, the chances for pregnancy is lowered.
  • High number of sperm with abnormal morphology will also lower the chances for pregnancy.
  • The timing of IUI.

How is IUI performed?

It is not necessary to abstain from intercourse before doing an IUI. However, our recommendation is to have intercourse on the day that an ovulation kit turns positive or on the day that the hCG trigger injection is given. The IUI is then timed as indicated above.

The semen sample is collected through ejaculation into a sterile container. Ejaculate is usually collected at the clinic in a private setting. In situations where the male partner fails or unable to produce the semen in the clinic, he is allowed to produce it at home and the specimen must arrive at the clinic within half an hour. It is also possible to use a specialized nontoxic collection condom. Please note that ordinary condoms cannot be used for IUI treatment.

We will schedule the male partner for semen collection approximately 1-2 hour before the IUI treatment. This allows time for the laboratory to wash the sperm prior to the treatment. When a man ejaculates, the fluid that is emitted is composed of two main components: seminal fluid and sperm. Seminal fluid contains many types of hormones and chemicals. One group of chemicals in particular can cause problems and are known as prostaglandins.

Sperm processing/ washing allows the doctor to concentrate the actively motile sperms into a small volume of culture fluid. Sperm do not remain alive in the culture medium for very long unless they are maintained at the right conditions – hence a prompt insemination after sperm processing is important.

Following the wash, it is time for the insemination procedure, which only takes a few minutes and does not cause much, if any, discomfort for the female. The doctor will insert a small catheter into the uterine cavity through the cervix and inject sperm directly into the uterus. The patient is able to resume normal activity following the IUI procedure. If pregnancy does not result from the initial IUI, the procedure may be repeated during the following cycles.

 

Difficult IUI Procedures

Sometimes, it will be difficult to pass the IUI catheter all the way into the uterus. Hence, the physician can either use a catheter which contains a flexible wire inside or a tenaculum can be used. This wire allows the physician to bend the catheter into a shape that will follow the path in the cervix more easily. It also gives a little bit more rigidity to the catheter which is normally very soft and floppy. Often this is all that will be needed to allow the IUI catheter to be inserted into the uterus.

Apart from that a tenaculum can be used to grab a hold of the cervix. The physician performing the insemination can tug on the cervix and thus straighten the angle between the cervix and uterus. This will also make it easier to pass the IUI catheter through. Having the patient fill her bladder before the procedure can also help straighten the angle.

Finally, ultrasound can be used to help the physician guide the catheter into the uterine cavity.

Usually, an IUI does not cause much discomfort for a woman. There can be some cramping afterward, but what is felt is probably due to ovulation rather than from the IUI itself.