Artificial insemination should not be used in women with blocked fallopian tubes. The tubes are often checked out with an x-ray test called a hysterosalpingogram.

Female age is a significant factor with IUI. Intrauterine insemination has very little chance of working in women over 40 years old. IUI has also been shown to have a reduced success rate in younger women with a significantly elevated day 3 FSH level, or other indications of significantly reduced ovarian reserve.

If the sperm count, motility and morphology scores are low, intrauterine insemination is unlikely to work (see the table with male factor IUI success rates at the bottom of this page). With significant male factor issues, IVF with ICSI is indicated and has high success rates for women under age 40.

IUI is most commonly used for unexplained infertility. It is also used for couples affected by mild endometriosis, problems with ovulation, mild male factor infertility and cervical factor infertility.

Insemination is a reasonable initial treatment that should be utilized for a maximum of about 3-4 months in women who are ovulating (releasing eggs) on their own. It is reasonable to try IUI for longer than this in women with polycystic ovaries (PCOS) and lack of ovulation that have been given drugs to ovulate.

How is insemination performed? What is the process for artificial insemination in humans?

1. The woman usually is given medications to stimulate development of multiple eggs and the insemination is timed to coincide with ovulation - release of the eggs.
   
   
2. A semen specimen is either produced at home or in the office by masturbation after 2-5 days of abstinence from ejaculation.
   
   
3. The semen is "washed" in the laboratory (called sperm processing or sperm washing). The sperm is separated from the other components of the semen and concentrated in a small volume. Various media and techniques can be used for the washing and separation. Sperm processing takes about 30-60 minutes.
   
   
4. A speculum is placed in the vagina and the cervical area is gently cleaned.
   
   
5. The washed specimen of highly motile sperm is placed either in the cervix (intracervical insemination, ICI) or higher in the uterine cavity (intrauterine insemination, IUI) using a sterile, flexible catheter.

The intrauterine insemination procedure, if done properly, should seem similar to a pap smear for the woman. There should be little or no discomfort.

Most clinics offer for the woman to remain lying down for a few minutes after the procedure, although it has not been shown to improve success rates. The sperm has been put above the vagina and cervix - it will not leak out when you stand up.

Semen cup - ready and waiting for you

Picture of artificial insemination procedure

Intrauterine insemination success rates vary considerably and depend on:

• age of the woman
  
  
• type of ovarian stimulation used (if any)
  
  
• duration of infertility
  
  
• cause of infertility
  
  
• number and quality of motile sperm
  
  
• other factors
  

Success rates for IUI in women over 35 drop off, and for women over 40 they are much lower. For this reason, we are more aggressive in "older" women.

Pregnancy rates are lower when insemination is used:

• in women over 38 years old
• in women with low ovarian reserve
• with poor quality sperm
• in women with moderate (or severe) endometriosis
• in women with any degree of tubal damage or pelvic scarring
• in couples with a long duration of infertility (over 3 years)

The rates are slightly higher for women that do not ovulate on their own (anovulation) that are stimulated to ovulate with medication and then inseminated. The sole cause of their infertility is likely to be the ovulation problem - which is hopefully overcome with the drugs.

For a couple with unexplained infertility, female age under 35, trying for 2 years, and normal sperm - we would generally expect about:

• 8% chance per month of conceiving and delivering with artificial insemination and Clomid for up to about 3 cycles (lower percentages with Clomid and insemination after 3 attempts)
• 12% chance per month of conceiving and delivering with injectable FSH medication (e.g. Follistim, Gonal-F, or Menopur) and insemination for up to about 3 cycles (lower after 3 attempts)
• 55% chance of conceiving and delivering with one cycle (month) of IVF treatment (at our center - success rates vary greatly between clinics)

Our IVF pregnancy and delivery success rates

Insemination treatment in conjunction with ovarian stimulation with Clomid tablets (clomiphene citrate) vs. insemination after stimulation with injectable gonadotropins (Follistim, Gonal-F, Bravelle, Menopur)

According to many published studies, intrauterine insemination with partner's sperm in conjunction with ovarian stimulation yields a higher pregnancy success rate than insemination in natural menstrual cycles (no ovarian stimulation).

Details about success rates with Clomid alone vs. Clomid plus IUI vs. injectables

Insemination combined with ovarian stimulation with injectable gonadotropins provides higher pregnancy rates (and higher multiple pregnancy rates) as compared to insemination combined with Clomid.

More about multiple birth risks with ovarian stimulation drug treatments

How many infertility treatment cycles should be done with insemination?

Most pregnancies resulting from insemination with the male partner's sperm occur in the first 3 attempts. The chances for success per month drop off after about 3 attempts and drop considerably more after about 4-5 unsuccessful attempts. Therefore, IUI treatment is usually recommended for a maximum of about 3 or 4 tries.

If the reason for infertility is lack of ovulation, it may be reasonable to try more IUI cycles. However, many couples with fertility problems are ready to move on to IVF treatment after 3 IUI's have failed.

Costs of fertility treatments are an important factor in deciding when to move on beyond inseminations for many couples. The relative cost-effectiveness of IUI decreases substantially after 3 failed attempts.

In vitro fertilization is the next step in treatment after inseminations - with a much higher success rate per cycle.

Cervical vs. intrauterine insemination

The intrauterine insemination procedure is more effective than intracervical insemination. By placing the sperm higher in the female reproductive tract, more sperm will get to the area in the fallopian tube where they might have a successful date with the egg(s).

More about inseminations versus IVF as a fertility treatment option

There are many published studies that address this. Some studies show no improvement in pregnancy success rates with two inseminations done on sequential days as compared to one well-timed insemination. Other studies show higher pregnancy rates when two inseminations are done on back to back days.

A possible explanation for the different findings is that if single inseminations are not properly timed for ovulation, success rates would improve with a double insemination protocol. At least one of the 2 insems might be timed correctly.

Most fertility experts believe that one well-timed IUI is sufficient.

How important is timing of the IUI?

Any insemination should be carefully timed to occur at or a little before the time of ovulation. We know that in some couples, sperm can remain viable in the female reproductive tract and result in fertilization of an egg for five days (after having sex).

Eggs are fertilizable for only about 12-24 hours (maximum) after ovulation. Therefore, IUIs must be properly timed so that sperm show up for the date while the eggs are still viable.

Studies have shown that intrauterine insemination can be effective for some cases associated with poor sperm quality. However, if the total motile sperm count at the time of insemination (after the processing) is less than 5 million, the chances for pregnancy are substantially lower.

If the total motile sperm count is below 1 to 5 million, success rates are very low. Therefore, in vitro fertilization with ICSI (injecting sperm into the eggs) is usually done for these cases.

Sperm count and pregnancy

Sperm counts are not perfect predictors of fertilizing potential and pregnancy. Rare pregnancies do happen with total motile counts of less than one million. The converse is also true - sometimes "normal sperm" don't fertilize eggs well. The biochemical defect in sperm is not always reflected in what we see microscopically.

Risks of artificial insemination in women

The risk for complications with intrauterine insemination is very low. The woman could develop an infection in the uterus and tubes from bacterial contamination that originated either in the semen sample, or through a contamination of the sterile catheter in the vagina or cervical area during the procedure. Careful cleaning of the cervix and cautious technique make this a rarity.

Cost of artificial insemination treatment

The cost of intrauterine insemination with partner's sperm, including semen processing is usually between $300 and $800. It varies considerably between fertility clinics. If ultrasound and blood monitoring of follicle development is done there are additional charges.

The cost of fertility treatments as well as the cost of fertility drugs are sometimes covered by the female partner's health insurance.

However, in many plans there is no coverage for infertility services, or there is coverage for "diagnostic testing", but not for treatment. The fertility clinic can investigate the couple's health insurance coverage for fertility care before treatment begins.