IUI, Intrauterine Insemination
Intrauterine insemination (IUI) is a painless procedure where a small catheter is used to pass concentrated sperm through the vagina, past the cervix, and into the uterus.
The semen analysis is crucial to documenting the sperm's ability to fertilize an egg. Our andrology laboratory uses the “Kruger Strict Criteria” to evaluate semen, unlike most commercial laboratories. This testing helps predict IUI success and indicates if more advanced treatments like IVF using ICSI are needed.
Clomid (clomiphene citrate) or Femara (letrozole) tablets, often combined with injectable follicle stimulating hormone (FSH), are usually given to improve ovulation and increase the chance of pregnancy. These drugs increase the number of mature eggs and also increase progesterone production, which fosters development of the uterine lining.
Lupron, Antagon, Cetrotide, or Ganirelix are used in FSH cycles to prevent premature ovulation. Once the eggs mature an injection of human chorionic gonadotropin (hCG) is given to stimulate ovulation and the IUI is scheduled 36-40 hours later. Two intrauterine inseminations done 24- 48 hours apart may be considered if ovulation has been unpredictable. Sometimes two or more IUI cycles are needed and one is done each month that ovulation can be accurately predicted.
Cycles combining oral medications with FSH offer excellent success rates and ours are among the highest in the region. The incidence of multiple births in cycles managed by a fertility specialist is low (<20% for twins and <2-3% for triplets). We monitor IUI cycles closely and if too many eggs develop, we either cancel the cycle or convert to an IVF cycle.
Most fertility specialists agree that if IUI has not worked in 4-6 treatment cycles other therapies, such as IVF, should be tried. IVF yields better per cycle success rates; however, the cost to achieve pregnancy may be higher.
When is IUI the Best Treatment Choice?
- Cervical factor infertility – Prior cervical treatment for dysplasia (cryotherapy, laser of the cervix, LEEP, etc.) or poor cervical mucus production.
- Lack of conception after trying drugs like Clomid.
- Unexplained infertility.
- Mild endometriosis.
- Older women with good ovarian reserve.
- Mild to moderate male infertility.
- Male ejaculatory problems.
- Use of frozen sperm.