Intrauterine insemination (IUI) is a procedure in which the sperm is placed into the uterus around the time of ovulation. The procedure is done in the doctor’s office and does not hurt any more than a pap smear. This is most commonly done for male factor infertility, low sperm count, abnormal sperm, or use of donor sperm. It can be done with or without medications to increase ovulation rates.
When a woman gets IUI she comes to the doctor’s office when tests show she is ovulating. A speculum is placed into the vagina and a small plastic tube is placed through the cervix into the uterus. Prepared sperm is then placed into the uterus through the tube. This is all painless and very simple. The woman is asked to remain laying down for a short amount of time and then she can leave and return to her normal day.
Intrauterine insemination is most commonly used if there is male factor infertility. In this case the woman has normal anatomy and is ovulating regularly, there is just a problem with the sperm. This can be low sperm counts in which the man puts out very few sperm with each ejaculate. This can also be a problem with sperm function, the sperm do not swim well. Because IUI bypasses the vagina and cervix, the sperm get a big head start on their way to the fallopian tube thus making pregnancy possible even with fewer sperm or abnormally functioning sperm.
In the situation were the man produces no sperm or were there is no male partner, donor sperm can be used. Donor sperm is readily available for sale at a sperm bank. The most common situation is an anonymous donor where the woman does not know exactly who the sperm comes from and the man donating the sperm does not know who the sperm goes to. Even with anonymous donor sperm the woman usually gets some information about the donor. This information often includes a medical history of the donor, education level, race, and some physical characteristics. This information allows the woman to choose sperm that has genetic characteristics that she considers a good match. It is often possible to purchase sperm for later use in case the woman wants to get pregnant again and use the same donor sperm.
Another reason that intrauterine insemination is used is for unexplained infertility. This is the situation where a couple is not achieving pregnancy even when all the tests are normal and the doctors cannot find a reason that the couple is not getting pregnant. It is thought IUI can help in unexplained infertility for a variety of reasons. There may be cervical factors that we are not able to test for. It is thought that in some cases the sperm has trouble getting through the cervix. IUI bypasses the cervix and puts the sperm directly into the uterus closer to the egg. There also can be antibodies or other factors in the vagina or cervix that can be toxic to sperm, IUI avoids these as well. Even if none of these other factors exist, intrauterine insemination places the sperm much closer to the egg and increases fertility chances even in normal functioning anatomy.
Intrauterine insemination can be used alone but is more commonly done in conjunction with other fertility treatments. IUI by itself does not increase the risk of twins or higher order multiples. If it is used along side other fertility treatments, the risk of multiples is the same as the risk of the other technologies. Clomiphene Citrate (Clomid) is very commonly used with IUI. Clomid is given in the usual way and IUI is performed with ovulation. Injectible medications are also done in conjunction with IUI. Fertility medications are injected often daily to cause the ovary to ovulate. IUI is done with ovulation. Injectible medications have a fairly high risk of twins and can have higher order multiples as well.
Intrauterine insemination is fairly common treatment for infertility. It can be used by itself but is more commonly part of a treatment plan. It is fairly inexpensive, safe, and painless. It can be inconvenient for the woman. When ovulation is occurring the woman needs to be able to see the doctor right away to have the insemination done.