If you have struggled to conceive despite regularly engaging in unprotected sex, one of the many possible medical interventions that your doctor discusses with you might be intrauterine insemination, or IUI.
What is IUI?
IUI allows the sperm to bypass the vaginal canal and cervix by placing the sperm directly into the uterine cavity. The procedure is timed to happen as close to ovulation as possible to maximize your chances of conception. During intercourse, it is not uncommon for some sperm to be left in the folds of the vaginal wall, never quite completing its journey to meet the egg. Sperm can also encounter problems penetrating a tightly closed or scarred cervix or surviving a vaginal pH that may be slightly too acidic.
Why might I need IUI?
Although in-vitro fertilization may be the most well-known type of fertility treatment, IUI is both less invasive and less expensive. (Many insurance companies that cover IVF even require the patient to attempt a certain number of IUI cycles before they will cover any of the more invasive procedures involved in IVF.)
IUI may be recommended as a first line of treatment for patients trying to conceive using sperm from a donor. IUI may also be an option for couples who are unable to have sexual intercourse during the fertile period, either due to sexual dysfunction or a partner who travels frequently or is deployed. In cases of separation or donation, sperm can be frozen for use in future IUI cycles. IUI may also be a good option for couples dealing with sperm motility that falls in the borderline-low to normal range. Some cases of unexplained infertility, especially in females under the age of 38, may also benefit from IUI.
To be a candidate for IUI, patients need to have at least one open fallopian tube and a sufficient number of motile sperm.
What is involved in the IUI process?
Medications: IUI can be completed with or without medications to induce the growth of one or more eggs. Your doctor may recommend that you take letrozole or Clomid for five days, usually early in your cycle. Injectable medications can sometimes be used as well. Injectable prescriptions are typically a bit more powerful than oral medications, which is why most physicians prefer to try IUI with an oral medication first. You may also be prescribed a one-time hormone injection to trigger the release of one or more of the mature eggs.
Monitoring. Depending on whether a cycle is medicated or unmedicated, your provider will discuss ways to monitor your hormone levels. In a natural cycle, you will time your IUI or trigger shot with your natural ovulation. During a medicated cycle, this may include urine ovulation tests, bloodwork, or pelvic ultrasound. (Ultrasound is more commonly used when medications are prescribed along with the IUI cycle.)
Sperm collection and processing. A semen specimen is provided either by your partner or a sperm donor. The semen then undergoes a process called sperm-washing in a lab. Fresh or frozen semen can both undergo the sperm washing procedure. During this process, the sperm is separated from the rest of the seminal fluid.
Insemination procedure. The insemination itself is a fairly simple process. Once you and your physician have identified that you are ovulating, the washed sperm is placed into a very thin cannula with a syringe at the end. Most patients describe this procedure as causing minimal discomfort, and it might feel similar to a pap smear. Anesthesia is not required, and the insemination itself takes less than five minutes. You may be asked to remain on your back for several minutes after the insemination. There are no activity restrictions or bedrest requirements after IUI.
What is the success rate of IUI?
The overall success rate of each IUI cycle is between 10 and 20 percent, but much of this depends on the reasons for IUI being performed and the age of the female. Chances may be higher in patients with no known fertility challenges, such as couples unable to have intercourse due to travel or sexual dysfunction and patients using donor sperm. The age of the female is one of the most important determining factors to success rates of IUI cycles.
When do I find out if I am pregnant?
After undergoing a procedure like IUI, you will likely be anxious to find out whether or not it has resulted in a pregnancy. Bloodwork or a urine pregnancy test should be accurate about 14 days after the IUI procedure. If you attempt a home pregnancy test before this time, you may receive a false positive result because of the hormones in the trigger shot.