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Dr. Sejal Patel Discusses IUI

What is an IUI?

IUI is referred to as intrauterine insemination (IUI) and is a therapy where sperm can be placed past the cervix and into the women’s uterus around the time of ovulation.

Naturally, sperm travels from the vagina, through the cervix and into the uterus prior to traveling to the fallopian tube to meet the egg. If they meet, fertilization will occur and an embryo will form.

However, there are many barriers to this process, such a sperm traveling into the cervix and then traversing the cervix to reach the uterus. This is where intrauterine insemination can help.

Male factor:

Intrauterine insemination can be used when there is a male factor to the fertility picture. If there is a lower sperm count than expected, the sperm can be concentrated for placement directly into the uterine cavity. If the sperm have low motility, the motile sperm can be separated through a washing process (density gradient and centrifugation) and placed into the uterine cavity to have the best chance of moving into the fallopian tube. If there are antibodies or abnormally shaped sperm, these can be removed in the washing process. In addition, some men may have abnormalities to the reproductive tract like retrograde ejaculation where sperm are ejaculated back into the bladder. The sperm can be removed from the bladder, prepared and placed into the uterine cavity to help with conception.

Cervical abnormalities:

Intrauterine insemination can also be used when there may be abnormalities in the cervix. If the patient has had a LEEP or cone biopsy in the past to remove abnormal cervical cells, this procedure can remove a part of the cervix which contains the mucus glands to facilitate sperm movement into the uterine cavity. Intrauterine insemination will bypass this obstacle. In addition, sometimes the sperm and cervical mucus do not interact well and an intrauterine insemination can also address this issue.

Donor sperm:

Finally, intrauterine insemination can be utilized when undergoing intrauterine insemination using donor sperm. This is utilized when a male partner has no sperm or the sperm quality is too poor for in vitro fertilization. In addition, this can be used by single women or married same sex couples who want to start their family.

Cryopreserved sperm:

In some cases, men may preserve their sperm prior to cancer therapy, surgery or at a young age which can be utilized later via intrauterine insemination to help with conception.

Collection:

Sperm collection can occur via a number of ways. The most common is masturbation into a sterile plastic container. The collection can be done at home or in the office. If at home, the sperm must be delivered within 40 minutes of collection. The sperm may also be collected in a special sterile condom that can be obtained from our office at CRM. This collection method may result in a lower yield of sperm based upon the surface area of the condom. Men with retrograde ejaculation can also provide urine from which sperm can be retrieved for IUI.

Sperm Preparation:

An intrauterine insemination is performed around the time of ovulation. The partner will bring in a semen sample and the semen is separated from the sperm. Live sperm are then separated from nonviable sperm. The live sperm are then placed into a density gradient to separate the highly motile sperm from the others. The most directionally motile sperm are removed from the gradient and placed into fluid similar to the human fallopian tube for insemination.

For the patient:

Typically an intrauterine insemination is performed after placement of a speculum to visualize the cervix. Once completed, the cervix is rinsed of any mucus or debris. A fine catheter containing the sperm in human tubal fluid is then placed just past the cervix into the uterine cavity and once accurate placement is determined, the sperm sample is then slowly injected into the uterine cavity. The procedure should not cause significant pain or cramping, but occasional cramps or spotting can occur.

Normally after the procedure, the patient is asked to rest in a supine position for 15 minutes. That evening, relations (unless using donor sperm) is recommended. Two weeks after the intrauterine insemination a urine pregnancy test is performed.

Success rates:

Success rates will depend upon the diagnosis, age of the woman and seminal parameters. If the age of the patient is advanced or the seminal parameters are lower than normal, pregnancy rates will be reduced. Overall, IUI as a treatment (not per cycle) yields a pregnancy rate of around 40%.

Risks:

Risks from an IUI are quite low. The chance of infection is rare. Other risks to the IUI include whether a woman is also taking additional medications which may increase her risk of multiples. IUI does not alone increase the risk of multiples.

IUI is quite a successful therapy and should be reviewed as a potential option with your reproductive endocrinologist at CRM.

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