Intrauterine Insemination (IUI) is one of the most commonly performed reproductive procedures in the world. In one form or another, it has been used for hundreds of years. Today’s technology involves inserting washed, concentrated sperm directly through the vaginal canal into the uterus. “Unwashed” sperm must never be placed in the uterus, as serious and sometimes even fatal allergic reactions can occur.
IUI is particularly useful when there are infertility issues related to the cervical mucus. The mucus must be thin and watery to help the sperm swim to the site of fertilization near the end of the fallopian tubes. The mucus must also be free of antisperm antibodies (ASA), which can damage or kill sperm. Antisperm antibodies occur when the female’s immune system mistakes the sperm for invading pathogens and mounts an antigen/antibody reaction to destroy them. In rare cases, the male may make antisperm antibodies that kill his own sperm, usually as an after-effect of testicular trauma.
IUI is a first-line treatment for conditions such as unexplained infertility. In most cases, IUI is done in stimulated cycles, meaning Clomid or FSH has been taken to increase follicle production, thus increasing the chances of a successful conception. When women undergo ovulation induction with FSH, they must come to our office for repeat ultrasound monitoring and estradiol measurements. These tests ensure that the follicles, each of which contains an egg, are developing properly. The tests also lower the chances of adverse drug reactions such as hyperstimulation syndrome.
IUI cycles should only be performed by a trained infertility specialist/reproductive endocrinologist. Infertility specialists undergo years of advanced training in FSH administration and the management of stimulated cycles. One risk of IUI is that it increases the chance of multiple births because the number of eggs ovulated cannot be strictly controlled. This is unlike IVF, where a set number of embryos are transferred to the uterus. Most of the high order (>4) births reported in the media are the result of IUI cycles that were administered by a non-specialist. Specialists are trained to limit the chances of this unwanted side effect.
Depending upon the couple's history, three IUI cycles will usually be tried, after which IVF is often the next choice. In many cases of infertility due to issues such as tubal disease, advanced female age, and male factor, IVF is the first-line treatment and IUI is not attempted.
Read the IUI policy on using donor sperm
