Intrauterine insemination is frequently a part of recommended therapy for infertility.
This procedure involves precise timing, just prior to ovulation, with submission of a sperm sample by the husband and a laboratory process called “washing” which effectively removes secretions from the prostate and most of the bacteria which may be present in sperm specimens. The “sperm washing” process takes about 1 hour. Insemination is then performed with a very small and flexible plastic catheter placed through the cervix with injection of the concentrated sperm up into the uterus and fallopian tubes. The procedure is brief and painless.
Intrauterine insemination or IUI as it is commonly called, is useful if any aspect of the sperm quality is diminished to place more high quality sperm into the fallopian tubes than is accomplished with intercourse. The chance for pregnancy depends heavily on the overall sperm quality prior to the wash process. The “wash” process does not separate high quality sperm from low quality sperm.
IUI is also used in conjunction with ovulation treatment for the female even when the husband’s sperm count is normal. Scientific publications support this form of therapy as a way to improve fertility of unknown cause.
TIME OF INSEMINATION
The timing of IUI may be determined in one of several ways. An ovulation predictor kit is the most useful method. We recommend “Clear Blue Digital”. The kit instructions are easy to follow and this simple urine test will forecast ovulation – to occur one-two days later. Inseminations may be performed on the initial day of kit peak or the following day – in our experience the resultant pregnancy rate is the same. In a small percentage of people, the predictor kits do not provide clear information and then you will be instructed to come in at mid-cycle for an ultrasound evaluation of the ovaries and possible administration of a drug to stimulate egg release (hCG). IUI would be timed accordingly. The third method of timing is controlled by Gonadotropin therapy. Patients receiving Gonadotropins for induction of ovulation will also have hCG given to stimulate egg release and that will determine the time of IUI.
PRIOR TO STARTING IUI
Prior to beginning IUI, we recommend (but do not require) the husband be tested for the presence of HIV and also Hepatitis B and C. The purpose of these tests is to reduce your risk of disease transmission since IUI is different from intercourse in this regard. We recommend that the husband have these tests repeated yearly-or more often if medical treatments like blood transfusion or other high-risk behaviors (such as intravenous drug use or a new sexual partner) that increase the risk of acquiring these diseases.
RISKS OF IUI
There is a risk of uterine-tubal infection following IUI. In our experience, this risk is extremely low, less than 1%.
Sterile physiologic solutions are used to wash the sperm prior to IUI. The presence of protein in these solutions improves the yield of motile, useful sperm. The protein used for this purpose in our laboratory is human serum albumin (HSA). HSA is derived from the noncellular component of human blood, which has been sterilized and purified based on current state-of-the-art-knowledge. Blood donors are screened in accordance with current Centers for Disease Control Guidelines , including points of medical history related to the possible risk of Creutzfeldt-Jakob disease transmission. There has never been a documented case of disease transmission related to the use of HSA.
MORE THAN ONE IUI PER CYCLE
There may be a higher pregnancy rate with more than one IUI per cycle. If you are using a predictor kit, the inseminations are done on the first day of kit change and the following day. If you are being treated with drug therapy, a physician will instruct you about IUI timing.