Intrauterine Insemination
Intrauterine insemination (IUI) is one of several methods of assisted conception used in the treatment of cases when there is no obvious cause for the couple's infertility.
IUI is one of the simpler methods of assisted conception, which might be considered in couples thought suitable. IUI will usually be only considered in couples whose first investigations have failed to detect a specific cause of infertility and who have been trying for a baby for at least two years and where the female is under 35 years of age.
Tests required prior to being considered for IUI will include blood tests to assess hormone levels and ovulation; patent fallopian tubes either by an hysterosalpingogram (HSG) or by laparoscopy and dye test for women, and a normal semen analysis for the men.
The objective of IUI is to introduce a quantity of semen into the female partner's uterus (womb), thereby encouraging fertilisation. The technique allows prepared sperms to pass beyond the cervix into the uterus using a fine IUI catheter.
Studies show that IUI will not be effective in cases where the male has a low sperm count, or poor sperm shape. Similarly, women with damaged tubes will not be helped by IUI.
The procedure:
For an increased chance of success, the female partner is given drug treatment, to encourage two or three follicles to mature. This is usually by either tablets i.e. Clomiphene citrate or by injection.
Around mid-cycle the ovaries are monitored by ultrasound to measure the growth of the follicles, individualise drug dosage and prevent serious side effects.
Once the follicles have reached maturity (around 18 –20mm) an injection of HCG (Human Chorionic Gonadotrophin) will be given, timed at around midnight, so that ovulation can be controlled to about 36 hours later. The appointment for the IUI will also be booked.
On the day of the procedure, the male partner will need to produce a semen sample. The ejaculate can be produced at home, and then the sample bottle must be kept at body temperature i.e. in a pocket and brought to the fertility unit within one hour of production. The couple then meet the microbiologist who will be preparing the sample for IUI. This procedure takes approximately 2 hours; during this time there is no need to remain within the fertility unit. You will need to arrive back at the unit at a pre arranged time, the female will need to have a full bladder for the IUI procedure. The procedure itself takes approximately 5 minutes; you will be able to rest for 5-10 minutes afterwards if you wish to. The male partner can stay throughout the treatment, if the couple wish. When you go home there are no restrictions on normal lifestyle.
A pregnancy test may be done two weeks after the procedure, if the period has not started. If it is positive then the treatment has been successful. If the period starts then the couple can decide if they wish to start another cycle.
The risks involved are few. In some cases where there are multiple follicles present the chance of multiple pregnancy is greater. Hyperstimulation can occur with the drugs involved to induce ovulation, but careful monitoring during the mid-cycle reduces this.
The success rate of IUI is between 10% to 15% per cycle.
We advise that by the time you consider treatment the female has a body mass index (BMI) < 30, cervical smears are up-to-date and you are both non-smokers. Treatment will only be offered when the above lifestyle changes have been successfully made.
NICE no longer advise that you have IUI before considering IVF. Its main usage is if there is either sexual difficulty or if donor sperm is used.