Intrauterine Insemination (IUI)
IUI is a very cost-effective method for conceiving for many couples. It is also used frequently for solo moms and lesbian couples. If, after several attempts, it is not successful, IVF is usually the next step.
At a Glance
- Also known as artificial insemination, places sperm cells into the woman’s uterus
- IUI is used for unexplained infertility and mild male factor infertility
- Can use donor sperm when the man has no sperm or very poor sperm, as well as for lesbian couples and single women who wish to be solo moms
- IUI is a low-cost fertility treatment and may be the first treatment used
IUI for Unexplained Infertility
Patients who have been trying to conceive without success for over one year may consider intrauterine insemination (IUI). If there is no diagnosis to explain the infertility after thorough evaluation resulting in normal sperm count, tubes, and ovulation, IUI is an option to consider. Generally speaking, if there is a male factor problem, IUI is not recommended. The sperm are a key factor as they must move from the uterus to the fallopian tubes in order to achieve a pregnancy. The success rate can be half of normal if the sperm count is low, and if the sperm count is profoundly low, it is near zero success.
In IUI, also known as artificial insemination, oral medication is used to stimulate the ovaries to produce eggs. The development of the follicles is monitored with ultrasound. Once large follicles are noted, a "trigger drug" called hCG or OvidrelTM is given. Then 24 to 40 hours later, insemination is done. The sperm specimen is washed to prevent adverse factors in seminal fluid from getting into the uterus. The washed sperm is inserted in the uterus with a small catheter.
IUI vs IVF
IUI is a very cost-effective method for conceiving for many couples. A good rule of thumb is three IUI cycles is similar to one cycle of IVF in terms of outcomes. There is an old rule that only three or four IUIs should be done before doing IVF. However, evidence in 2020 has been presented, which shows that patients can successfully achieve pregnancies with IUI up to seven or even eight times before moving on to IVF. Obviously, how many cycles of this treatment are appropriate becomes a matter of choice and decision making with the couple.
Single women who choose to be solo moms can do IUI successfully if their tubes and uterus are normal. IUI can be used with donor sperm if there is a male factor. Lesbian or gay couples who wish to have a baby can do IUI as well.
When considering IUI, one must consider the success rate for couples in their mid 30s to be plus or minus 17%. Patients over 40 or with low ovarian reserve typically have diminished results. Patients facing results of only 7 - 8% per cycle may wish to move on to IVF sooner.
Some people do not wish to spend the time on a lower success procedure such as IUI and wish to move on to IVF which has a higher success rate in a shorter amount of time.
Risks of IUI
Because of the drugs used to produce multiple eggs, there is always a risk of multiple pregnancies. For the most part, with oral medication, there are singleton pregnancies. However, the twin risk can be as high as 20 to 25% and, according to the literature, there is a 5% chance of triplets. If intramuscular gonadotropin therapy is added to IUI, the risk of high-order multiple pregnancies such as triplets is dramatically increased. Thus, this is usually not performed.
Sometimes the medication can cause cysts on the ovaries. If a woman does not conceive in the first cycle, an ultrasound is done during her period to make sure no cyst occurs. These cysts can become painful and grow if not monitored properly. Typically, these cysts go away spontaneously in a month, occasionally taking longer.