Intrauterine Insemination – IUI Treatment

Intrauterine insemination (IUI) is one of two methods of artificial insemination (AI), a conservative treatment option recommended for couples with unexplained infertility or with problems with the man’s sperm.

An alternative form of AI is intra-cervical insemination (ICI), which consists of placing the sperm into the cervix with the aid of a syringe, plastic cap, or sponge. In comparison, IUI consists of placing the sperm directly into the uterus by passing a catheter through the cervical canal.

Recent information indicates that IUI offers a higher probability of pregnancy than ICI. Since more sperm will reach the top of the uterus through IUI than through ICI, there will be more sperm available for fertilization. Therefore, we only perform IUI in our office to provide the highest chance for pregnancy.

The IUI procedure can be done using either a partner’s sperm or donor sperm. Washing the sperm cells is necessary to remove bacteria, white blood cells, and substances that the cervix would normally filter. Sperm can live in the female reproductive tract for 48 hours and therefore proper timing of the insemination is extremely important.

To enhance the odds of success, IUI is often combined with fertility medications. Some of the “fertility drugs” include clomiphene citrate (Clomid or Serophene) or gonadotropins (Bravelle, Gonal-F, Follistim, Pergonal or Repronex).

Ovarian Stimulation and IUI Treatment

The normal menstrual cycle can range from 21 to 35 days, with ovulation occurring around the 14th day after the onset of bleeding and the LH surge occurring about two days earlier. An insemination without medication is known as a “natural or non-stimulated cycle.”

A non-stimulated cycle will always be the least expensive treatment option, followed by clomiphene citrate cycles, and gonadotropin induced cycles, which are one of the most expensive alternative.

It’s important to note that recent studies suggest that the best chances of pregnancy are achieved when IUI is coupled with ovulation induced by fertility drugs either clomiphene citrate (7%) or injectable gonadotropins (18%) than with IUI (4%) alone. This is the case for couples with infertility associated with specific diagnoses as well as those with unexplained infertility.

When exogenous hormones are used the ovaries are stimulated to produce more than one follicle, two to four is the ideal. For this reason, physicians refer to this as “controlled ovarian stimulation” or “super-ovulation.”

The choice between the methods is based on maternal age, other specific medical conditions, previous history, prior response to fertility medications and the couple’s or patient’s wishes. In general, it is recommended to offer three or four cycles with clomiphene citrate, and if conception does not occur, consider evaluating the pelvic cavity for adhesive disease and endometriosis prior to further treatment.