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Intrauterine insemination (IUI)
By Mayo Clinic staffOriginal Article: http://www.mayoclinic.com/health/intrauterine-insemination/MY00104
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Definition
Intrauterine insemination (IUI) is a procedure for treating infertility. The procedure for intrauterine insemination is straightforward; it takes about 15 to 20 minutes and is usually done in a doctor's office or clinic. Sperm that have been "washed" and concentrated are placed directly in your uterus on the day after your ovary releases one or more eggs to be fertilized. The hoped-for outcome of intrauterine insemination is for the sperm to swim into the fallopian tubes and fertilize a waiting egg, resulting in a normal pregnancy.
Depending on the reasons for infertility, intrauterine insemination can be coordinated with your normal cycle or done in conjunction with fertility medications.
Why it's done
A couple's ability to become pregnant depends on many different factors. Intrauterine insemination is used most often in couples who have:
- Mild male factor infertility (subfertility). Your partner's semen analysis, one of the first steps in the medical assessment of infertility, may show below-average sperm concentration, weak movement (motility) of sperm, or abnormalities in sperm size and shape (morphology). IUI can overcome these problems because preparing sperm for the procedure helps separate the highly motile, normal sperm from those of lower quality.
- Cervical factor infertility. Your cervix is at the lower end of the uterus and provides the opening between your vagina and uterus. With intercourse, your partner ejaculates into your vagina, and the sperm swim through the cervical opening into your uterus, then to the fallopian tubes to search for a waiting egg. The fluid produced by the cervix around the time of ovulation is supposed to provide an ideal environment for sperm to travel from your vagina to the fallopian tubes. However, if the cervical fluid is too thick it may impede the sperm's journey. Intrauterine insemination (IUI) bypasses the cervix, depositing sperm directly into your uterus and increasing the number of sperm available to meet the awaiting egg.
- Semen allergy. Rarely, women have an allergy to proteins in their partner's semen, so ejaculation into the vagina causes redness, burning and swelling where the semen has contacted the skin. A condom can protect you from the symptoms, but it also prevents pregnancy. If your sensitivity is severe, IUI can be effective, since many of the semen proteins are removed before the sperm is inserted.
- Unexplained infertility. IUI is often performed as a first treatment for unexplained infertility, sometimes in conjunction with ovulation-inducing medications.
- Donor sperm. For people who need to use donor sperm to get pregnant, IUI can be used to achieve pregnancy. Frozen donor sperm specimens are obtained from certified labs and thawed before the IUI procedure.
Risks
Intrauterine insemination is a relatively simple and safe procedure, and the risk of serious complications is low. Risks include:
- Infection. Less than 1 percent of women experience infection as a result of the procedure.
- Multiple pregnancies. Particularly when coordinated with ovulation-inducing medications, the risk of multiple pregnancies increases significantly. Multiple pregnancies inherently have higher risks than do single pregnancies, including early labor and low birth weight.
How you prepare
Intrauterine insemination involves careful coordination before the actual procedure.
- Preparing the semen sample. Your partner provides a semen sample at the doctor's office, or a vial of frozen donor sperm can be thawed and prepared. Because nonsperm elements in semen can cause reactions in the woman's body that interfere with fertilization, the sample will be "washed" in a way that separates the highly active, normal sperm from lower quality sperm and other elements. The likelihood of achieving pregnancy increases by using a small, highly concentrated sample of healthy sperm.
- Monitoring for ovulation. Because the timing of IUI is crucial, your doctor may monitor you for signs of impending ovulation using transvaginal ultrasound, which is an imaging method that lets your doctor visualize your ovaries and egg growth. Alternatively, you may be asked to monitor yourself using an at-home urine ovulation predictor kit.
- Determining optimal timing. Just before ovulation, your body produces a surge or release of luteinizing hormone (LH). If you're coordinating IUI with your normal cycle, you'll go in for insemination the day after the LH surge. If you're using ovulation-inducing medications, you may be given an injection of human chorionic gonadotropin (HCG) to make you ovulate, and then go in for the insemination the next day.
What you can expect
An IUI takes place in your doctor's office or clinic. Your doctor or a specially trained nurse performs the procedure. The IUI procedure itself requires no medications or pain relievers.
During the procedure
First, you'll change into a hospital gown. Next, while lying on an exam table, you'll put your legs into stirrups and a speculum will be inserted into your vagina — similar to what you experience during a Pap test.
The doctor or nurse then inserts a long, thin, flexible tube called a catheter into your vagina, through your cervical opening and into your uterus. A vial containing the small sample of healthy sperm is attached to the end of the catheter, and the sperm sample is pushed through the tube into your uterus. The doctor or nurse then removes the catheter, followed by the speculum.
After the procedure
The intrauterine insemination procedure usually takes 15 to 20 minutes. After insemination you'll be asked to lie on your back for a brief period. After the procedure is over, you can get dressed and go about your normal daily activities. You may experience some light spotting for a day or two after the procedure.
Results
Wait for two weeks before taking an at-home pregnancy test, when pregnancy hormone levels are at a measurable level. Testing too soon could result in a false-negative — meaning that the test result is negative when, in fact, you really are pregnant. Conversely, if you're using ovulation-inducing medication such as HCG, testing too soon could produce a false-positive — a test result that indicates a pregnancy when you really aren't pregnant — due to the HCG that's still circulating in your body.
Your doctor may instruct you to return for a blood test, which is more sensitive in detecting pregnancy hormones after fertilization.
If you don't become pregnant, you might try IUI again before moving on to other fertility treatments. Often, the same therapy is used for three to six months to maximize chances of pregnancy.
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- Hornstein MD, et al. Treatment of unexplained infertility. http://www.uptodate.com/home/index.html. Accessed July 2, 2010.
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- Dickey RP, et al. Effect of diagnosis, age, sperm quality, and number of preovulatory follicles on the outcome of multiple cycles of clomiphene citrate-intrauterine insemination. Fertility & Sterility. 2002;78:1088.
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