Breaking Down the Intrauterine Insemination (IUI) Process

What is Intrauterine Insemination?

Intrauterine Insemination (IUI), also commonly known artificial insemination (AI) is a technique that can help treat certain kinds of infertility in both men and women. IUI is usually recommended to accompany ovulation induction cycles to increase pregnancy chances. When an IUI is performed, the semen, after its seminal plasma has been washed off, is directly injected into the uterus.

When is IUI Recommended?

When male infertility is a factor, IUIs empirically improve pregnancy rates over regular intercourse. It also improves pregnancy rates if cervical factor infertility is present (i.e. the cervical mucus inactivates semen motility) and in the presence of mildly abnormal semen, which can constitute a case of general male infertility. 

How is IUI Performed?

The Intrauterine Insemination process includes preparing and delivering sperm so that a highly concentrated amount of active motile sperm is placed directly through the cervix into the uterus. IUI is typically performed with fertility drugs for the female patient. Thus, for infertility patients, IUI is commonly performed as a low-tech, cost-effective approach to enhancing fertility in patients. 

There are several techniques available for preparing the sperm for IUI. All of the techniques involve separating sperm from seminal fluid. It is not possible to inject semen that has not been separated directly into the uterus because of chemicals in the fluid that can cause extremely painful uterine contractions. We primarily use a method of sperm separation called "Density Gradient Separation". In this technique, motile sperm are separated from dead sperm and other cells through the use of viscous solution. Approximately 2 hours are required to process the sperm. After preparation, the sperm concentrate is placed through the cervix into the uterus by using a thin, flexible catheter. The time required for insemination is ~5-10 minutes. The patient may experience mild cramping during the procedure but this symptom should resolve shortly after the procedure is completed. There is a small risk of infection following this procedure (less than 1%). A hysterosonogram should be performed prior to IUI to document at least one open fallopian tube. 

Every male partner providing a semen specimen for IUI preparation must be tested for infectious diseases. If a woman is using donor sperm from a sperm bank, we require that she have infectious testing performed prior to initiating donor sperm inseminations. The specific tests required are HIV, HTLV I, RPR (a test for syphilis), Hepatitis B Surface Antigen, and Hepatitis C antibody. 

What is the timeline of IUI?

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An IUI procedure uses a small catheter to place washed, concentrated sperm directly into your uterus. You may or may not need medication to stimulate ovulation. Here's a breakdown of an IUI Cycle:

Natural Cycle IUI:

• No medication is required to stimulate follicle growth.
• Monitoring visits are conducted to track natural ovulation.
• Sperm is placed around the time of ovulation.
• The procedure is done in the doctor's office.
• Timeline: Approximately 2 to 4 weeks, depending on the timing of ovulation.

Medicated Cycle IUI:

• Ovarian stimulation medications are used to stimulate follicle growth.
• A couple visits to the doctor for bloodwork, ultrasounds, and medication instructions.
• Medications, such as oral or injectable fertility drugs, are taken to stimulate follicle development.
• Monitoring visits are scheduled to track follicle growth.
• Once follicles reach the desired size, a trigger shot may be administered to induce ovulation.
• The IUI procedure is scheduled within 24 to 36 hours after the trigger shot.
• The sperm sample is washed in a lab to remove seminal fluid and debris.
• The prepared sperm sample is placed directly into the uterus using a catheter during the IUI procedure.
• Timeline: Approximately 2 to 4 weeks, depending on the duration of ovarian stimulation and timing of the procedure.

It's important to note that the actual timing and specific medication protocols may vary based on individual circumstances and the recommendations of your provider. Consult with a fertility specialist for a more personalized and accurate timeline for your specific IUI cycle.

Does IUI Increase Success Rates?

Studies suggest success rates with IUI are enhanced with the addition of moderate treatment of the female partner with medications. A decision regarding medication to stimulate the ovaries is made in consultation with the physician. Alternatively, patients may be advised to take injectable fertility drugs which are more aggressive in stimulating multiple egg release from women (the more eggs that a woman produces during a treatment, the higher the chance for success but also, the higher the chance of a multiple pregnancy). 

Though the pregnancy rates for women undergoing artificial insemination may not be as high as they are for some more advanced techniques, this technique has a key advantage: it's a simple procedure with few side effects.