IUI – Intrauterine Insemination
Intrauterine insemination (IUI) is a procedure that is often one of the first treatment choices for many infertility patients.
In outline, IUI is planned around the time of ovulation and involves a semen sample being processed in the laboratory to extract and concentrate the motile sperm. This sperm preparation is then replaced into the uterus using a small catheter.
WHO IS IUI SUITABLE FOR?
IUI may be an option for many infertility patients; however it is not appropriate for patients with tubal infertility because the fallopian tubes need to be open and functioning for the sperm and egg to meet.
Moderate male factor infertility, can often be treated very effectively with this technique because sperm are concentrated in the laboratory preparation process. While most cases of severe male factor infertility will require IVF and ICSI, some couples may opt to use donor sperm in these circumstances, in which case IUI may again be an appropriate form of treatment.
IUI is also a very common first line treatment for women with ovulatory infertility who do not ovulate readily or at all. As IUI is often used in combination with Ovulation Induction, sperm is placed directly into the uterus after stimulating the ovaries to produce an egg and ovulate.
WHAT DOES IUI INVOLVE?
The way in which an IUI cycle is managed and whether and how fertility medications are used, will vary between patients. In all cases the response of the ovary is monitored during the cycle by ultrasound scans. The egg is contained within a bubble-like ‘follicle’ which can be seen developing on the surface of the ovary. The follicle must rupture to release the egg into the top of the fallopian tube during ovulation. By assessing the size of the follicle the clinician can determine when ovulation should or is likely to take place and can time the insemination appropriately.
For some women, IUI may just involve the clinician monitoring her normal menstrual cycle and inseminating around the predicated time of ovulation. For others after monitoring follicle development in the natural cycle, ovulation may be specifically ‘triggered’ by a hormone injection. For many women though, IUI is used in combination with ‘Ovulation Induction’ which involves taking oral or injectable medication (such as Clomid or FSH) early in the cycle to stimulate follicle development. Once the follicle(s) is mature a ‘trigger’ injection is given to stimulate ovulation and the insemination is usually performed 12-48 hours later.
On the day of the insemination, the male partner produces a semen sample (or a sample of donor sperm is thawed). In the laboratory, the sperm are separated from the seminal fluid, white blood cells, prostaglandins and other debris present in the ejaculate and a concentrated preparation of 5 million motile sperm or more is produced.
The woman attends the clinic a few hours later and a speculum (as used in a Pap smear) is inserted into the woman’s vagina and a catheter is passed through the cervix into the uterus. The sperm preparation is then injected and the catheter and the speculum are removed. IUI is usually not a painful procedure.
ARE THERE ANY RISKS?
- OHSS (Ovarian Hyper-stimulation Syndrome)
The main risk of ovulation induction is Ovarian Hyper-stimulation Syndrome (OHSS), when a woman over-responds to the ovulation induction protocol and can become very sick. Fertility specialists therefore carefully monitor IUI cycles by ultrasound scans and sometimes blood tests and are trained to adjust medication dosages to minimse this risk.
- Multiple Pregnancy
At Life Fertility Clinic an IUI procedure is not performed if there are more than 2 dominant follicles viewed on ultrasound because otherwise the risk of multiple pregnancies is too high.
- How successful is IUI?
IUI is less expensive than IVF, but the per cycle success rates are significantly lower (approx 10%).
If no pregnancy results after three to four cycles, the clinician will review the treatment and in vitro fertilisation may be the next step.
For more information or queries regarding any of the services offered at Life Fertility Clinic, please contact us.