Intrauterine insemination is also called artificial insemination, or IUI. Human artificial insemination with the male partner's sperm can be used as a potentially effective treatment for infertility of all causes in women under about age 45 except for cases with tubal blockage, severe tubal damage, very poor egg quality and quantity, ovarian failure (menopause), and severe male factor infertility
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IUI is most commonly used for infertility associated with
- Endometriosis,
- Unexplained infertility,
- Anovulatory infertility,
- Mild degrees of male factor infertilities,
- Cervical infertility
- Some couples with immunological abnormalities.
The most common use (by far) is IUI for unexplained infertility.
- Insemination is a reasonable initial treatment that should be utilized for a maximum of about 3-6 months in women who are ovulating (releasing eggs) on their own.
- IUI can be reasonable to use it for somewhat longer than this in women with polycystic ovaries (PCOS) and lack of ovulation that has been stimulated with drugs to ovulate.
- Artificial insemination should not be used in women with blocked fallopian tubes. Tubal patency should be demonstrated prior to performing inseminations. This is usually done with an x-ray study called a hysterosalpingogram.
- Intrauterine insemination has very little chance of working in women that are over 40 years old.
- IUI has also been shown to have a reduced success rate in younger women with a significantly elevated day 3 FSH level, or other indications of significantly reduced ovarian reserve.
- If the sperm count, motility and morphology scores are moderately to severely reduce from normal, intrauterine insemination is quite unlikely to be successful. In that situation, IVF with ICSI is indicated and has high success rates for women under 40 years old.
How is insemination performed? What is the process for artificial insemination?
- The woman usually is stimulated with medication to stimulate multiple egg development and the insemination is timed to coincide with ovulation - release of the eggs from the follicles.
- A semen specimen is either produced at home or in the office by masturbation after 2-5 days of abstinence from ejaculation.
- The semen is "washed" in the laboratory (called sperm processing or sperm washing). By this process, the sperm is separated from the other components of the semen and concentrated in a much smaller volume.
- A speculum is placed in the vagina and the cervical area is gently cleaned.
- Then the separated and washed specimen consisting of a purified fraction of highly motile sperm is placed either in the cervix (intracervical insemination, ICI) or higher in to the uterine cavity (intrauterine insemination, IUI) using a sterile, thin and soft catheter.
Intrauterine insemination has a better success rate than intracervical insemination. Therefore, it is the preferred method at the large majority of fertility specialist centers.
Picture of artificial insemination procedure
In the real world, sperm are not visible without a microscope
Intrauterine insemination success rate
Success rates for intrauterine insemination vary considerably and depend on the age of the woman, type of ovarian stimulation (if any) used, duration of infertility, cause of infertility, number and quality of motile sperm in the washed specimen, and other factors. Rates for women over 35 drop off, and for women over 40 are much lower.
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