Intrauterine Insemination (IUI)
Sometimes referred to as artificial insemination, intrauterine insemination (IUI) can be useful in some cases of minor male factor infertility and cervical factor infertility (not common) such as abnormal or inhospitable cervical mucus; however, this form of treatment is often over used and misused. Ongoing research and literature reports overall low success with this form of treatment care versus In Vitro Fertilization (IVF). A comprehensive investigation of both male and female factors is key before choosing to embark with IUI. Simple evaluation can assure that one does not utilize this form of treatment in suboptimal situations. The most common and under-assessed factor, prior to the utilization of IUI, is that of the male factor; specifically, a comprehensive semen evaluation including the evaluation of DNA Fragmentation.
IUI = Induction + Insemination
Intrauterine insemination (IUI) is the process by which a prepared and concentrated specimen of sperm is injected into the uterus through the use of a catheter. The procedure is done in the office and only takes a few minutes to complete. There is no pain and no requirement for anesthesia.
The treatment method of IUI begins with the process of ovulation induction. Methodology and protocols can vary amongst physician’s offices and fertility centers with regards to the treatment of IUI and especially regarding the initial process of ovulation induction. No matter the protocol, the goal is to stimulate the ovaries to ovulate a mature egg. Often, non-ART centers utilize a primary medication of clomiphene to induce the pituitary gland to release more of one’s own natural follicle stimulating hormone (FSH). Clomiphene is typically orally taken in a pill form and can be beneficial in some patients in stimulating a mature egg.
At MCRM, we utilized a protocol utilizing controlled ovarian hyperstimulation (COH) where the primary medication utilized is a synthetic, injectable form of FSH. As with clomiphene, the synthetic FSH is utilized to stimulate the ovaries in producing a mature egg; however, with the use of COH the goal is for multiple mature eggs to develop. The production of more than one mature egg increases the chance for a successful treatment cycle.
Patients undergoing IUI treatment, will be monitored utilizing ultrasounds and blood tests to verify egg development. Once it has been determined that a mature egg is ready, the patient will be instructed to utilize an hCG injection, often called a “trigger shot”, to initiate ovulation of the egg. Approximately 1 ½ days later, the IUI is performed.
On the day of insemination, the male partner, when applicable, will collect and provide a semen specimen to the MCRM lab. The lab will then take the fresh specimen, or in donor or prior collected sperm cases, frozen specimen, and begin to prepare, often referred to as “sperm washing”, the specimen for the IUI. This process will allow for a concentrate of the most active sperm to be available for insemination. The “concentrate” will be placed into a catheter and presented to administering provider to complete the IUI process.
With the right circumstances in place, IUI is an excellent and valuable treatment option. These include:
Minor Male Factor Infertility
When either low count or motility is present then these factors are often amenable with IUI. It should be noted that if this is the only problem that a couple has, then certainly medications for insemination can often be very effective. However, if they are coexistent female factors (ovulation dysfunction, endometriosis, tubal disease, age related female factors, etc.) then this dramatically alters the probability of success. So, the entire couple’s picture needs to be taken into consideration when looking at whether IUI is an appropriate treatment and one should have realistic expectations on success depending upon these issues.
Generally, this is a very rare phenomenon. Sometimes, the patients have had either a cold knife conization or multiple LEEP procedures for abnormal Pap smears; then this may lead to a cervical factor that necessitates fertility treatment that may benefit utilizing intrauterine insemination. In addition, for patients that may exhibit an isthmocele from a prior C-section, intrauterine insemination with surgical management of the isthmocele can be of benefit in restoring fertility.