Intrauterine insemination (IUI) or artificial insemination (AI) refers to the injection of sperm into the uterine cavity through the cervix and above the cervical level at or around the time of ovulation to improve pregnancy chances. Artificial insemination is useful in cases of unexplained infertility, male factor infertility, ejaculation problems and for single or lesbian women desiring pregnancy.
In cases of male factor infertility where count or motility is low, IUI is an effective treatment option. Although not commonly used anymore, intracervical insemination (ICI) is also a treatment option for cases of unexplained or mild male factor infertility cases. This approach is no longer preferred because higher pregnancy rates can be accomplished with IUI treatment compared to ICI. In cases of failed treatments with IUI or severe male factor cases, in vitro fertilization (IVF) with or without Intracytoplasmic Sperm Injection (ICSI) is the preferred treatment option. This treatment type is collectively referred to as artificial insemination.
Artificial insemination procedures involves collection of sperm in the doctor’s office followed by sperm washing in the embryology laboratory with sterile culture media (solution) containing antibiotics to eliminate any bacteria, debris, prostaglandins and proteins from the sperm. Following this washing step, sperm swim-up technique is commonly used to obtain the motile (actively moving forward) sperm for injection into the uterus. The artificial insemination procedure is relatively painless and involves placement of the speculum into the vagina to visualize the cervix, followed by introducing a sterile IUI catheter through the cervix and into the uterine cavity with injection of sperm. Patients are generally advised to rest for 10-15 minutes and can then resume regular activities. Progesterone supplementation is generally started following IUI and continued until the end of the first three months or a negative pregnancy test in two weeks.
Success rates are higher in the presence of normal sperm parameters and lower depending on the severity of the sperm count, motility and morphology (appearance of sperm – ≥14% is considered normal). In cases of low morphology, IVF-ICSI becomes a better option with higher pregnancy rates.
Artificial insemination can be combined with clomiphene citrate (Clomid) treatment or injectible gonadotropins (Gonal F, Follistim, Menopur, Repronex, Bravelle) and typically doubles the pregnancy rates compared to cycles in which medications are used alone with timed intercourse. IUI is typically performed the next day following spontaneous ovulation detected by ovulation predictor kits (OPK) and in some cases repeated in 24 hours. When ovulation is triggered by HCG injection, IUI is typically done 34-42 hours following the injection. Single or double inseminations result in similar pregnancy rates in cases of timed ovulation with HCG injections. However, if ovulation is spontaneous or sperm count is low, repeat insemination can be useful and recommended in most cases. Although there is no set limit on the number of insemination cycles that a couple can undergo, 3-4 cycles of treatment can be continued until moving on to a more aggressive treatment option such as IVF. In some cases, this duration may be shorter depending on additional factors such as low ovarian reserve, low sperm count, motility and morphology or poor response to treatment.