Insemination IUI is an assisted reproduction method used when a woman has at least one non-blocked, passable fallopian tube. Insemination is performed if the partner’s sperm quantity or motility is insufficient for conception. Sperm quantity over 5 million/ml together with motility of 50% in the a+b category is considered the lower limit for a chance to conceive. However, conception is not impossible with lower parameters; only the chances are quite low. A definite indication for IUI includes an immunologic cause of infertility in which the woman’s cervix contains sperm antibodies which do not let the sperm pass through it. IUI is also performed when the sperm analysis results are normal but the woman suffers from ovulation problems. In such cases, the insemination is performed after ovulation induction.
3D animation: IUI, source: www.youtube.com (Patreskovic)
IUI can be done in women with a normal ovulation process and a natural menstrual cycle. Otherwise, hormonal stimulation of the ovaries is required during which the ovaries can develop more than one egg simultaneously.
For an IUI method, the sperm is prepared in the laboratory by selecting the one with the highest motility factor. Then, the sperm is placed into the uterine cavity, which shortens the journey to the egg and enhances the chances of conception. If the man does not show any sperm cells present in the ejaculate or has very low quality sperm, an IUI can be performed by using donor’s sperm. Sperm donors are young, intelligent, healthy men who are genetically tested and test negative for STDs (sexually transmitted diseases). The donor sperm can be used only after a 6-month wait period, when it is confirmed that the donor does not show STDs. Sperm donation is anonymous, but it is possible to select a donor based on similar appearance to the patient’s partner – for example, based on hair or eye color.
1. Hormonal stimulation of the ovaries
Clomifene citrate (Clostilbegyt) is the basic medication used for stimulation. Other, much more expensive alternatives are hormonal injections with gonadotrophins containing the follicle-stimulating hormone FSH. Payment for this type of treatment must be approved by the appropriate medical insurance company.
a) Pills
One pill usually taken twice a day between day 3-7 of the menstrual cycle.
b) Injections
Applied daily, either intramuscularly or subcutaneously from the third day of the menstrual bleeding on.
2. Follicle growth observation
On the tenth day of the menstrual cycle, the patient comes in for an ultrasound to evaluate the quantity and the size of the follicles in the ovaries and the condition of the endometrium. Best conditions for IUI involve a scenario when one or two dominant follicles are being developed. If the quantity of the follicles is higher, there is a risk of a multiple pregnancy. This is because no method exists that could change the number of ovulating follicles and the number of the eggs released from them which will get fertilized and nested shortly after.
If more than three follicles are being developed, one solution is to extract the unnecessary follicles, leaving only the best two or one of them. If this solution is not successful, it is usually recommended to not conceive this time and to engage in a protected sexual intercourse.
If the biggest one of the follicles is 18mm in size and the endometrium is thicker than 8mm, the intramuscularly applied injections are used, containing between 5,000 to 10,000 units of human chorionic gonadotrophin – hCG (one or two doses), which will induce ovulation.
3. IUI Procedure
Intra-uterus insemination follows approximately 36 – 40 hours later. For this procedure the gathered sperm (the sample should be taken the morning before the IUI performance or the frozen sample can be used) are prepared using a specialized method. While the solution is being prepared, the most motile sperm cells are chosen. This is an outpatient procedure.
A catheter (a plastic tube with diameter of 1.5 mm) is inserted into the uterus and it is used to inject the sperm solution. The procedure is not painful. Sexual abstinence before an IUI is recommended if the partner’s sperm count is lower than normal. After the IUI, daily sexual intercourse is recommended. Only a few minute bed rest is sufficient for recovery. The patient is able to return to work the same day.
4. After IUI
Administration of progesterone is recommended during the natural menstrual cycle to enhance the function of the corpus luteum, which supports the early stages of pregnancy. One progesterone pill is ingested every morning and evening (1 – 0 – 1). It can be inserted into the vagina or swallowed. Vaginal application is preferred because, besides being absorbed by the blood stream, the medication can directly access the endometrium. We recommend using one pill of progesterone, three times per day for hormonal stimulation of the ovaries for IUI.
The IUI method has its limitations. The success rate of this method does not exceed 12%, which is rather low. If the couple does not conceive after the third IUI cycle, the IVF – ET method (outside the body fertilization – embryotransfer) is recommended.
Every woman is eligible to have 6 IUI cycles per year (usually three with two sperm applications in a two day interval) covered by health insurance. Additional payments may be required to cover medication costs (according to the type).
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