Intrauterine Insemination (IUI)

Intrauterine insemination (IUI) is a method of artificial insemination in which sperm is collected, concentrated, and placed inside a woman’s uterus using a catheter. The insemination occurs during a woman’s menstrual cycle when eggs are released. During the procedure, patients experience minimal to no discomfort.

Depending on the cause of infertility, IUI procedures may be synced with a woman’s natural menstruation cycle. In some situations, fertility medicine is used as part of the IUI process.

Traditional conception requires a great deal of biological coordination and timing. To be successful, the sperm must travel from the vaginal canal, through the uterus, and into the fallopian tubes at the same time that an egg is traveling through the same fallopian tube. For successful conception to occur, the sperm must penetrate the egg and fertilize it to create a zygote.

The sperm’s journey is a challenging one, even in the best of circumstances. The journey to fertilization can be further complicated when fertility issues are present. For example, if a male partner has a low sperm count, there are fewer chances that sperm will be able to successfully reach an egg when it is in the fallopian tube.

Intrauterine insemination works in two ways:

1. It reduces the length of the sperm’s journey.
2. It improves the chances of fertilization by using a specially prepared semen sample containing the strongest sperm.

First, semen is collected from the male partner or sperm donor. The semen is prepared through a process called sperm washing, where the sperm are separated from the non-sperm elements of the semen. Using centrifugation, the stronger sperms are separated from the others, resulting in a sample of highly sperm-concentrated semen.

Next, the female patient is monitored for ovulation. This can be done at home using ovulation predictor kits or by a fertility specialist, who will use a transvaginal ultrasound to observe the size and growth of follicles in the ovary as well as hormone levels to determine when ovulation will occur. In some cases, medications are used to increase the number of eggs being developed at once and some patients receive a human chorionic gonadotropin (HCG) injection to facilitate ovulation. The IUI procedure is then performed within a day or two of ovulation.

During the exam, the female patient lies on the exam table with her legs in stirrups so that the doctor can insert a speculum into the vaginal opening. This feels very similar to a standard Pap smear exam. The concentrated sample of semen is attached to a catheter, which is inserted into the vagina, through the cervix, and into the uterus. The sperm then travels through the catheter into the uterus, where it will continue the rest of the journey.

IUI and in vitro fertilization (IVF) are two of the most common fertility treatments. While they do share some similarities, they are very different procedures and are often recommended in different circumstances.
The main similarity between these procedures is the use of specially prepared semen. In IUI, the semen is placed directly into the uterus so that the sperm can continue swimming towards the egg. In IVF, eggs are extracted from the female patient’s ovaries and combined with the specially prepared sperm in a laboratory so that sperm can fertilize the egg. Once the resulting zygote has developed for about five days, it is what’s known as a blastocyst. The blastocyst is then transferred to the recipient’s uterus.

IUI may be the recommended treatment in a wide range of scenarios, including:

• When using donor sperm
• Mild male factor infertility
• Unexplained infertility
• Ovulation issues
• Mild endometriosis-related fertility issues
• Cervical issues

IUI is a non-invasive, in-office procedure that takes about 10 to 15 minutes to perform. During the procedure, patients can expect to feel some minor discomfort when the speculum is inserted, similar to a regular vaginal exam. Most patients report barely feeling the catheter, due to its size and flexibility.

After the procedure has been completed, patients must lie down for a little bit. Afterward, they can go about their day as normal. Some women experience mild cramping or spotting for a day or two.