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Intrauterine Insemination

I’ve spent a significant amount of time discussing the infertility treatment in-vitro fertilization (IVF). While IVF is an outstanding treatment for many patients, there are instances when the treatment intrauterine insemination (IUI) is a viable option. Most fertility clinics, including where I practice—Pacific Fertility Center, perform IUI. Intrauterine insemination (IUI) is the process of preparing and concentrating a sperm specimen for the most active motile sperm and placing the washed sperm into the uterine cavity. Intrauterine insemination is often recommended because studies have shown that pregnancy is more likely to occur if timing of exposure to sperm is controlled, and if sperm is placed in higher numbers in the uterus.

IUI is often recommended for women or couples who:

- have ovulatory dysfunction and are undergoing ovulation induction;
- are unable to have normal intercourse with ejaculation into the vagina at
appropriate times;
- have mild male factor infertility;
- have unexplained infertility;
- are using donor sperm;
- have failed other treatments, such as Clomiphene alone.

In some cases, IUI is performed in natural cycles without the use of any fertility medications. However, studies in the fertility literature have demonstrated that, especially in combination with clomiphene citrate (Clomid or Serophene) or gonadotropin (Gonal-f, Repronex or Follistim) administration, IUI significantly increases chances of conception.

The Intrauterine Insemination Process

There are many techniques available for preparing the sperm, most of which are derived from in-vitro fertilization laboratory techniques, or from study of sperm behavior in the laboratory. The goal in sperm processing is to separate the sperm cells from the seminal fluid, fluid that can be irritating to the uterine lining. In the process, the most active, motile sperm are concentrated and separated from dead sperm, cellular debris and bacteria.

The sperm can be collected at home and brought to our office within 1.5 hours or can be produced in our clinic’s sperm collection room. The laboratory will then perform a sperm count and motility evaluation and prepare the sperm. The usual preparation procedure takes about two hours. After preparation, the sperm concentrate is placed into the uterus, through the cervix, using a small catheter. Some of the sperm will also be placed directly into the cervix. The actual insemination process takes approximately 5 to 10 minutes.

In the vast majority of cases, IUI is a completely painless process. Some inseminations are accompanied by cramping, but this is usually very mild and transient. It is not necessary to remain lying down after the procedure and you may immediately resume your usual activities.

Preparing for an IUI Cycle

During your consultation with your physician, you will create a treatment plan. Some couples need testing done to determine the best treatment option. These tests vary, depending on the evaluation already completed and the reason for considering IUI. Will the test help to diagnose your infertility? Will it change your individual treatment plan? Is the information worth the expense of the test? In most cases, the status of the fallopian tubes needs to be determined and ovulation needs to be verified. In addition, the quality of the sperm needs to be assessed. All women who have regular menstrual cycles should have a cycle day 2 or 3 FSH and estradiol blood level test.

In California, where I practice, every husband/partner/donor giving a semen specimen for IUI must be tested for infectious diseases. This testing is required by California State law and must be complete, with results in our office, before an IUI can be done. There are no exceptions to this policy. The specific tests required are HIV, HTLV I, RPR/VDRL, Hepatitis B Surface Antigen, and Hepatitis C Antibody. Depending on the lab used and/or the doctor ordering the testing, the test results can take 7 days to 2 weeks to arrive in the fertility clinic. We advise all those considering IUI to have these tests done as soon as possible to avoid added stress at treatment time. Patients are responsible for ensuring that these lab tests are their medical records. Once testing is complete, a woman can waive repeat testing for subsequent treatment cycles by signing a waiver.
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About the Author

Dr. Herbert is a fertility expert and an innovator in the field.