Intrauterine insemination (IUI) is a common infertility treatment, which involves placement of sperm past the cervix directly into the uterine cavity using a small catheter.
IUI is a common initial treatment for unexplained infertility, and IUI can be employed for mild male factor infertility, and ovulatory dysfunction as well. IUI is also appropriate treatment for individuals who have problems involving the cervix where cervical fluid is inadequate secondary to prior treatment for an abnormal pap smear or as a side effect of certain medications.
IUI is not appropriate for severe male factor, severe tubal disease, and uterine disease. While other assisted reproductive techniques such as in vitro fertilization (IVF) are generally associated with higher pregnancy rates, IUIs are often considered as a first line of treatment due to its lower costs and greater convenience.
Typically before IUI treatments are considered, an initial round of basic fertility testing has already been completed. Ideally, a pelvic ultrasound is normal and tubal patency has been established by a tubal dye or contrast study.
Similarly, IUIs work best when the semen analysis is normal or mildly abnormal. In ideal circumstances, a lack of pelvic endometriosis or scar tissue as determined by laparoscopy will be associated with better pregnancy rates with this form of treatment.
Unfortunately, the laparoscopy is somewhat costly and if not covered by insurance many couples will elect to proceed with IUIs without the potential benefit of the laparoscope.
Most IUI cycles involve the administration of Clomid, Letrozole, follicle stimulating hormone (FSH), or these medications in combination, to cause the ovary to produce multiple eggs. These cycles are carefully monitored to limit side effects and help minimize high order multiple births.
The most common method of monitoring egg number and maturation involves the use of pelvic ultrasound. Blood estradiol hormone levels are sometimes used to assess follicular development and prevent potentially serious medication side effects.
Once it has been determined that the egg number is acceptable and maturation is confirmed, another medication called hCG is administered and the timing of the IUIs is commonly performed one and two days after the hCG has been administered.
Occasionally, due to low sperm counts, patient scheduling conflicts, or even bad weather, one IUI instead of two will be performed. We have seen many patients conceive under these circumstances as well. It has been shown by multiple studies that IUIs are more successful when used in combination with these medications.
However, given that these medications are also associated with an increased risk of multiple pregnancy; this should only be administered under the careful supervision of an infertility specialist thoroughly trained in its use.
On the day of the scheduled IUIs, sperm is collected at our office or brought in from home and processed by our staff. The IUI is then accomplished by placing the sperm past the cervix into the uterus with a small catheter and syringe. We recommend a brief period of rest (typically about 10 minutes) before resuming normal activities for the remainder of the day. Side effects are minimal, but can include cramping &/or a small amount of spotting.
Two to four IUI cycles are typically recommended before considering alternatives such as IVF. The success rates appear to be similar for the first four cycles. Thus, if you are not pregnancy after the first attempt it is reasonable to consider more treatments. It is generally not recommended, however, to continue with IUIs past a fourth attempt.
If IUIs are not successful, other options still exist for couples. As mentioned, some patients will opt for a more aggressive treatment such as IVF which generally has higher success rates per attempt than IUI. Some patients will opt for alternatives such as the use of donor sperm for IUIs where the sperm counts of the male partner are severely compromised.
Obviously, each couple is unique, and further consultation with Dr Bachus will be necessary to determine the next best course of action.