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Artificial insemination for infertility,
Intrauterine insemination - IUI
Advanced Fertility Center of Chicago
What is IUI? Intrauterine insemination is also called IUI or artificial insemination.
The IUI procedure can be an effective treatment for some causes of infertility in women under age 41. It is not effective for couples with:
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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 quite low, intrauterine insemination is unlikely to work.
- Details on IUI success rates according to the sperm numbers
- With significant male factor issues, IVF with ICSI is indicated and has high success rates
IUI is 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 months in women who are ovulating (releasing eggs) on their own. It is reasonable to try IUI for longer 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?
- The woman usually is given medications to stimulate development of multiple eggs and insemination is timed to coincide with ovulation - release of the eggs.
- A semen specimen is either produced at home or in the office by masturbation after 2-5 days of abstinence from ejaculation.
- 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.
- A speculum is placed in the vagina and the cervical area is gently cleaned.
- 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. The sperm has been put above the vagina and cervix - it will not leak out when you stand up.
Picture of artificial insemination procedure
Success rates for IUI
Details about success rates with IUIs at different ages and fertility situations
For a couple with unexplained infertility, female age under 35, trying for 2 years, and normal sperm - we would generally expect about:
- 10% chance per month of getting pregnant and having a baby with artificial insemination and Clomid for up to 3 cycles (lower success after 3 attempts)
- 15% chance per month of getting pregnant and having a baby with injectable FSH medication (e.g. Follistim, Gonal-F, Bravelle or Menopur) and IUI for up to 3 cycles
- 55% chance of conceiving and having a baby with 1 IVF cycle (at our center - success rates vary between clinics)
- Our IVF success rates
Chances for success 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.
IUI with Clomid or injectables
Many studies have shown that insemination with drugs to stimulate multiple eggs to ovulate gives a higher success rate than doing IUI without drugs, called natural cycle IUI.
Details about success rates with Clomid + IUI and injectables plus IUI
How many inseminations to try before doing IVF?
- The short answer is to move on to IVF after 3 failed IUIs
- If the female is age 40 or older, or ovarian reserve low, consider IVF earlier
- In vitro fertilization has a significantly higher success rate as compared to IUI
- More on when to move from IUIs to IVF
More on IUIs versus IVF as a fertility treatment option
Cervical vs. intrauterine insemination
IUI is more effective than ICI, 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).
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.
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 starts
- Call us for our fees for intrauterine insemination treatment
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