What is an Intrauterine Insemination (IUI)?
So you’re thinking about fertility treatments and wondering what all your options are? One thing to remember is that you don’t have to jump straight into in-vitro fertilization! Depending on your situation and your recommendation from your Reproductive Endocrinologist, there are other options that are less invasive that show promising results. One of those procedures is called intrauterine insemination, or IUI.
The Definition of Intrauterine Insemination (IUI)
Intrauterine insemination (IUI) is a common procedure that is performed for couples experiencing infertility. The theoretical reason to do an IUI is that it allows the placement of a concentrated sample of motile sperm directly into your uterus, thereby increasing the chance of fertilization and conception that month, as some common barriers in the female reproductive tract are bypassed.
Why is an IUI Necessary?
Normally, during intercourse, millions of sperm are deposited in the woman’s vagina in the hope that at least a few hundred will make it to the site of implantation, the fallopian tubes. In sperm-world, that’s pretty far away!
Sperm must journey all the way to the egg and are subsequently fraught with many barriers. It is more like an obstacle course for them! This lengthy journey can be a reason for infertility in some people. Some barriers are the acidic environment of the vagina and mucus produced by the cervix that is detrimental to sperm most days of the month.
That sounds intense, but the security-guard-like interference is actually a good thing… most days.
One of the ‘jobs’ of the cervix is to safeguard the uterus (which is sterile) from anything entering the vagina that can be a possible cause of infection. Great! In its protective role, though, it can prevent the passage of sperm. Bad… for those trying to conceive.
How Does an IUI Help Your Chances of Conceiving?
Depositing sperm directly into the uterus via an IUI therefore bypasses the vagina and cervix, giving sperm a better chance of reaching the site of implantation.
What Does an IUI Feel Like and What’s the Process?
The IUI process itself is relatively simple and painless. Most women report that it feels like a pap smear.
At RMA of CT, we often recommend a medicated IUI cycle, which combines IUI with ovulation induction medications in order to increase the number of eggs produced, matured, and available for fertilization that month.
The timing of the IUI is important and must be calculated based on your natural or induced ovulation. If natural ovulation is allowed to occur, the IUI should be scheduled the day of or the day after your over-the-counter urine ovulation predictor kit (OPK) test line turns positive. If you are undergoing a medicated cycle, you will be given a trigger injection which mimics your natural LH (pre-ovulation) surge. Trigger shots allow us to precisely time your ovulation and perform an insemination 24 to 36 hours later to assure that sperm are present in the reproductive tract before you ovulate (sperm live longer than eggs, so we want the sperm to be there ‘waiting’ for the egg).
The IUI Procedure
Step 1: Sperm Production
On the morning of the IUI, the male partner produces a sample in a collection room via masturbation (if donor sperm is being used, it is thawed then).
Step 2: Sperm Preparation
The sperm sample is viewed under the microscope and the total number of moving sperm (TMS) is calculated. The sample is then ‘washed’ (a process where any bacteria or substances that can be potentially irritating to you or detrimental to fertilization are removed). The final (washed) sample is then viewed by an andrologist and the TMS are recalculated, recorded, and placed in a vial with your name on it.
Step 3: Insemination
Before the insemination, you will be asked to confirm your name and identifying information on the vial containing the washed sample. Once confirmed, the sample is then drawn up into a flexible catheter which is inserted through the cervical canal into your uterus. We ask that you remain relaxed on the table for a few minutes after insemination just to assure that you are not having any cramping or adverse reaction to the procedure or the sperm wash (which is very rare).
Step 4: Wait
Once complete you can go home or back to work and continue your day as usual. A pregnancy test is scheduled approximately 14 days later.
Success Rate of IUI
The chance of conception after IUI varies and is dependent on multiple factors, such as the cause of infertility, the presence (and severity) of a male factor, your age, and the quality of the sperm sample that day.
At RMA of CT, we require a minimum of 5 million TMS in order to proceed with an IUI that month (chances of pregnancy are very low when < 5 Million), but we prefer that the sample is >10 million TMS.
How can men take care of their fertility?
In the setting of an adequate sperm sample, and in the absence of advanced age or poor ovarian reserve, there is a 15-20% chance of achieving a pregnancy that cycle when combined with oral ovulation induction agents. We usually recommend 3 months of trying with natural or medicated IUIs before consulting with your physician regarding next steps.
Is IUI Right for Me?
Overall, IUI is used very frequently as a treatment in the infertility setting and many couples achieve success with this intervention. It’s imperative to have complete fertility diagnostic testing so that you and your doctor can come up with a plan that is right for you.
It’s also important to note that some insurance companies mandate a set number of IUI trials prior to advancing to IVF. This can affect your treatment plan if insurance is covering part or all of your expenses.
Whether you start at IUI or utilize other technologies offered by your fertility practice, it’s important to have a team that has your best interests at heart. This is a major step toward your family building success, and we can’t wait to help you get there!
Are you ready to see if IUI could work for you?
About Monica Moore
As a nurse practitioner, Monica received advanced nursing education in addition to being a registered nurse. She is a fully licensed registered nurse and Advanced Practice Nurse Practitioner in the state of Connecticut and is certified by the board of the American Academy of Nurse Practitioners. Monica’s nursing work experience spans nearly two decades in the field of fertility treatment. Monica’s passion lies in taking care of the whole patient. Monica works with patients and stresses the importance of integrating comprehensive care – including yoga, acupuncture, massage therapy and nutrition – with fertility treatment.