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A Beginner's Guide to IUI
Contributed by Angie Boss Staff Writer


Intrauterine insemination (IUI) is a fertility procedure in which sperm are washed, concentrated, and injected directly into a woman's uterus. In natural intercourse, only a fraction of the sperm make it up the woman's genital tract. IUI increases the number of sperm in the fallopian tubes, where fertilization takes place. A very thin flexible catheter is inserted through the cervix and washed sperm is injected into the uterus.

Why Would I Need It?
IUI can help on Clomid cycles where cervical mucus is a problem, and IUI increases the chance of success on injectible cycles no matter what the sperm count. IUI is usually recommended for couples with no known cause of infertility who have been trying to have a baby for at least one year. You should have a thorough infertility investigation before trying IUI.

Under normal circumstances, IUI uses sperm from the male partner. However; another insemination technique, artificial
insemination by donor (AID) or therapeutic donor insemination (TDI), uses screened sperm samples from anonymous donors.
Women with ovulatory disorders can be candidates for IUI if they respond adequately to fertility drugs. In these cases, hormone treatments stimulate ovulation, and the IUI is timed to take place around the time of ovulation. Hormone treatments are usually used even for women without ovulatory disorders.

Women with endometriosis may benefit from IUI if they do not have a distortion of the pelvic structures. Women with mild endometriosis are usually treated similarly to women with unexplained infertility. Women with severely damaged or blocked
fallopian tubes will not be helped by IUI.

What are the Risks?
While complications of IUI are infrequent, they can include infection, brief uterine cramping, or transmission of venereal disease (from donor semen). Risks of the hormone treatment for controlled ovarian hyperstimulation include multiple pregnancy and
Ovarian Hyperstimulation Syndrome (large ovaries and collection of fluid in the abdomen). If more than three follicles mature, there is a risk of multiple pregnancy. Your doctor may choose to stop the treatment cycle. Multiple pregnancies tend to have
higher rates of miscarriage, lower birth-weight babies, and greater social difficulties. Your doctor may also stop the cycle if you have Ovarian Hyperstimulation Syndrome, a rare effect. Too high a dose of drug can cause excessive stimulation of the
ovaries, which you may notice as pain in the abdomen.

What is the Procedure?
First, drug treatment is initiated to encourage two or three eggs to mature. Usually Clomiphene pills or gonadotropin injections are used to stimulate the growth of follicles and cause ovulation. Then monitoring of treatment is done to measure the growth
of follicles, individualize drug doses, and prevent serious side effects. Because fertility drugs can produce several eggs, your doctor must monitor your progress during an IUI cycle for side effects and to reduce the risk of multiple pregnancy. The clinic will do blood tests to measure estrogen concentrations and use ultrasound to track the development of follicles. The usual aim in IUI is to generate three to five mature follicles. When two or three follicles have reached their target size, you will get an injection of the hormone hCG to induce ovulation.

The sperm sample, provided on morning of ovulation, is prepared and inseminated later that day. The fresh semen is collected by the male, then washed and concentrated. Using a fine catheter, the doctor inserts the sperm through the cervix and high into the uterus of the female partner. Pregnancy testing and early ultrasound monitoring follow.

When is it Done?
Ideally an IUI should be performed within 6 hours either side of ovulation (for male factor infertility, some doctors believe after ovulation is better). with the sperm waiting for the egg. When timing is based on an hCG injection, the IUIs are usually done between 24 and 48 hours later. Typical timing would be to have a single IUI at about 36 hours post-hCG If two IUIs are scheduled, they are usually spaced at least 12 hours apart between 24 and 48 hours after the hCG.

If no use of drugs is done, then doctors will base timing of IUI on a natural LH surge. In that case, a single IUI at 36 hours is the norm, but doing them at 24 hours is also quite common.

Does it Work?
The success rates are reported to be just under 6% and as high as 26% per cycle. The low statistics are with one follicle, while multiple follicles resulted in as high 26% success. In addition, if you have more than one IUI per cycle, you will increase your chances. Another influencing factor is sperm count. Washed sperm is supposed to only live for 6-12 hours, but sometimes as long as 24. This is not nearly as long as sperm can live in fertile cervical mucus (sperm can live up to 5 days in fertile mucus, 2-3 days being pretty common). This is why timing is so important.

Higher sperm counts increase the odds of success; however, there was little difference between success with good-average counts and those with high counts. The overall success rate seems to be between 15-20% per cycle.

Can I afford it?
It depends on what you can afford and what meds you are doing. One might do 3-4 IUIs on Clomid before moving on to injectibles, then do 3-4 cycles on injectibles. If one doesn't have success after four good ovulatory cycles on injectibles with well-timed IUI, it would be time to consider IVF. Costs for the actual insemination procedure alone can run anywhere from $120 to $400 each, with some clinics advising two inseminations per cycle.

What Else Should I Know?
It is also important that your clinic monitor your follicle growth and uterine lining conditions through blood work and ultrasound. These will insure that you are experiencing conditions conducive to better chances of conception. Without monitoring, you can not be sure of follicle growth, proper hormone levels, uterine lining or even of ovulation.

Does it Hurt?
Most women consider IUI to be fairly painless, along the same lines as having a pap smear. There can be some cramping afterward, but often what is felt is ovulation-related rather than from the IUI. The catheter often isn't felt because the cervix is
already slightly open for ovulation Most women can return to work that day, but may need to take a mild pain reliever. You will be given instructions on how long beforehand and afterwards to obstain from intercourse, and any resting periods after the IUI.