Intrauterine Insemination (IUI)
Intrauterine insemination (IUI) is a common and relatively conservative fertility treatment often recommended for couples facing unexplained infertility or challenges related to sperm quality or motility. For many patients, it offers a less invasive first step on the path to parenthood.
IUI is one of two types of artificial insemination (AI), the other being intra-cervical insemination (ICI). In ICI, sperm is placed into the cervix using a syringe, plastic cap, or sponge. In contrast, IUI involves placing sperm directly into the uterus using a thin catheter passed through the cervical canal, allowing more sperm to reach the fallopian tubes and improving the chances of fertilization. In IUI and ICI, either a partner’s sperm or donor sperm can be used.
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. As such, IUI is the only form of artificial insemination we perform at our fertility clinic to provide the highest chance for pregnancy.
Before the insemination, sperm is “washed” to remove substances such as white blood cells, bacteria, and other materials that the cervix would normally filter out. Timing is critical – sperm can survive in the female reproductive tract for 48 hours, thus making proper timing of the insemination extremely important.
To enhance the odds of success, IUI is often combined with fertility medications. Some of the “fertility drugs” used are Clomid, Serophene, Bravelle, Gonal-F, Follistim, Pergonal, or Repronex. An insemination without medication is known as a “natural or non-stimulated cycle.”
Ovarian Stimulation and IUI Treatment
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%), rather than with IUI (4%) alone. This applies to both 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 adhesions and endometriosis before further treatment.
