Intrauterine insemination (IUI) and its success rates

Introduction

If you are struggling to conceive, you may have heard of intrauterine insemination (IUI) as a possible fertility treatment option. But what is IUI exactly, and how does it work? Is it suitable for you, and what are the chances of success? How much does it cost, and what are the risks involved? In this blog post, we will answer these questions and more, to help you understand what IUI is and whether it is right for you.

IUI is a relatively simple and non-invasive procedure that involves placing sperm directly into the uterus of a woman who wants to get pregnant. The sperm can come from the woman’s partner or a donor, depending on the situation. The goal of IUI is to increase the number of sperm that reach the fallopian tubes, where fertilization of the egg occurs. By bypassing the cervix and the vaginal canal, IUI reduces the distance and obstacles that sperm have to overcome, and thus improves the chances of conception.

IUI is often combined with fertility medications that stimulate the ovaries to produce and release one or more eggs. This can further enhance the likelihood of pregnancy, as well as allow the timing of the procedure to coincide with ovulation. However, IUI can also be done without any drugs, in what is called a natural cycle, depending on the individual case.

IUI is a relatively low-cost and low-risk fertility treatment that can help many couples and individuals achieve their dream of having a baby. However, it is not suitable for everyone, and it does not guarantee success. In the following sections, we will discuss the factors that affect the suitability, effectiveness, and cost of IUI, as well as the steps involved in the procedure and the potential risks and complications.

Who can benefit from IUI?

IUI can be a good option for people who have difficulty conceiving due to various reasons, such as:

Unexplained infertility: This is when no clear cause of infertility can be found after testing both partners. IUI can help by increasing the chances of sperm and egg meeting, especially when combined with fertility drugs.
Mild endometriosis: This is a condition where the tissue that normally lines the uterus grows outside of it, causing pain and inflammation. It can affect the quality and quantity of eggs, as well as the ability of sperm to reach them. IUI can help by delivering sperm directly to the uterus, avoiding the affected areas.
Cervical or cervical mucus issues: The cervix is the opening of the uterus, and the cervical mucus is the fluid that it produces. The cervix and the cervical mucus play an important role in facilitating the passage of sperm into the uterus. However, some women may have a hostile cervix, meaning that it is too narrow, scarred, or inflamed, or a hostile cervical mucus, meaning that it is too thick, acidic, or sparse, to allow sperm to enter. IUI can help by bypassing the cervix and the cervical mucus altogether, and placing sperm directly into the uterus.
Low sperm count or motility: The sperm count is the number of sperm in a semen sample, and the sperm motility is the ability of sperm to move and swim. Both factors affect the chances of sperm reaching and fertilizing the egg. IUI can help by concentrating and washing the sperm, removing the non-motile and abnormal ones, and delivering them directly to the uterus, where they have a shorter and easier journey to the egg.
Ejaculation or erection problems: Some men may have difficulty ejaculating or maintaining an erection due to physical or psychological reasons, such as diabetes, prostate problems, anxiety, or stress. IUI can help by collecting sperm from the man in a comfortable and private setting, either by masturbation or by using a special condom during intercourse, and then transferring them to the woman’s uterus.
Same-sex couples or single women: IUI can help same-sex couples or single women who want to have a baby by using donor sperm from a sperm bank or a known donor. The donor sperm is screened and tested for any infections or genetic disorders, and then used for the IUI procedure.
Genetic disorders: IUI can help couples who want to avoid passing on a genetic disorder from the male partner to the child by using donor sperm from a sperm bank or a known donor. The donor sperm is screened and tested for any infections or genetic disorders, and then used for the IUI procedure.

IUI is not effective or recommended for people who have:

Moderate to severe endometriosis: This is a condition where the tissue that normally lines the uterus grows outside of it, causing pain and inflammation. It can affect the quality and quantity of eggs, as well as the ability of sperm to reach them. IUI may not help much in this case, as the problem lies in the ovaries and the fallopian tubes, not in the uterus. A more invasive and costly treatment, such as in vitro fertilization (IVF), may be needed.
Blocked or damaged fallopian tubes: The fallopian tubes are the tubes that connect the ovaries to the uterus, and where fertilization of the egg occurs. If the fallopian tubes are blocked or damaged by infection, surgery, or ectopic pregnancy, the sperm and the egg cannot meet, and pregnancy cannot occur. IUI cannot help in this case, as the problem lies in the fallopian tubes, not in the uterus. A more invasive and costly treatment, such as IVF, may be needed.
Severe male factor infertility: This is when the sperm count, motility, or morphology (shape and size) are very low or abnormal, or when the semen quality is very poor. IUI may not help much in this case, as the sperm may not be able to fertilize the egg even if they reach the uterus. A more invasive and costly treatment, such as intracytoplasmic sperm injection (ICSI), where a single sperm is injected directly into the egg, may be needed.

If you are considering IUI, your doctor will evaluate your medical history, perform a physical examination, and order some tests to determine your suitability and the best course of action for you. Some of the tests may include:

Blood tests: To check your hormone levels, such as follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol, progesterone, thyroid-stimulating hormone (TSH), prolactin, and others. These hormones affect your ovulation and fertility, and may indicate if you need any medication to stimulate your ovaries or to support your pregnancy.
Ovulation tests: To check if and when you ovulate, which is the release of an egg from the ovary. You can use urine test kits at home, or have blood tests or ultrasound scans at the clinic, to monitor your ovulation. This is important to time the IUI procedure correctly, as it should be done around the time of ovulation, when the egg is ready to be fertilized.
Semen analysis: To check the quality and quantity of the sperm, such as the sperm count, motility, morphology, and volume. This can help determine the chances of success with IUI, and whether any medication or treatment is needed to improve the sperm quality or quantity.
Hysterosalpingogram (HSG): To check the condition of the uterus and the fallopian tubes, and to see if there are any blockages, abnormalities, or infections that may affect the IUI procedure or the pregnancy. This is a type of X-ray that involves injecting a dye into the uterus and taking pictures of the dye as it flows through the uterus and the fallopian tubes.
Sonohysterogram (SHG): To check the condition of the uterus and the endometrium, which is the lining of the uterus, and to see if there are any polyps, fibroids, or adhesions that may affect the IUI procedure or the pregnancy. This is a type of ultrasound that involves injecting saline (salt water) into the uterus and taking pictures of the uterus and the endometrium as they expand with the saline.
Transvaginal ultrasound: To check the condition of the ovaries, the follicles, and the endometrium, and to monitor the growth and development of the eggs. This is a type of ultrasound that involves inserting a probe into the vagina and taking pictures of the pelvic organs.

How is IUI done?

IUI is a relatively simple and non-invasive procedure that can be done at a fertility clinic or a doctor’s office. It usually takes about 15 to 20 minutes, and does not require any anesthesia or sedation. However, some women may experience mild discomfort or cramping during or after the procedure.

The steps involved in the IUI procedure are:

Sperm collection: The sperm can come from the woman’s partner or a donor, depending on the situation. If the sperm comes from the partner, he will be asked to provide a semen sample by masturbating in a private room at the clinic, or by using a special condom during intercourse at home. The semen sample should be collected after two to five days of abstinence, to ensure the best quality

Sperm preparation: The semen sample is taken to a laboratory, where it is processed and washed to separate the sperm from the other components of the semen, such as seminal fluid, dead cells, bacteria, and debris. The washing also removes any chemicals that may inhibit fertilization or cause an allergic reaction in the woman. The sperm are then concentrated and placed in a small amount of culture medium, which provides nutrients and protection for the sperm. The sperm preparation takes about an hour, and results in a small volume of sperm suspension that contains the best and most motile sperm.
IUI procedure: The woman is asked to lie down on an examination table, with her legs in stirrups. The doctor or nurse inserts a speculum into the vagina, to hold it open and expose the cervix. The cervix is then cleaned with an antiseptic solution, to prevent any infection. A thin, flexible catheter is then inserted through the cervix and into the uterus. The sperm suspension is then injected through the catheter into the uterus, using a syringe. The catheter and the speculum are then removed, and the woman is advised to lie down for about 15 to 20 minutes, to allow the sperm to travel to the fallopian tubes. The woman can then resume her normal activities, but may be advised to avoid strenuous exercise, alcohol, caffeine, or smoking for the rest of the day.

What are the success rates of IUI?

The success rates of IUI depend on many factors, such as the age of the woman, the cause and duration of infertility, the quality and quantity of the sperm, the use and type of fertility drugs, the timing and frequency of the IUI procedure, and the number of cycles attempted. In general, the success rates of IUI are higher for younger women, for couples with unexplained infertility or mild male factor infertility, for cycles with fertility drugs, for cycles with multiple IUIs, and for cycles with more than one attempt.

According to a review of studies, the average pregnancy rates per cycle of IUI are:

8.3% for women under 35 years old
5.6% for women between 35 and 39 years old
2.7% for women between 40 and 42 years old
1.3% for women over 42 years old

The average live birth rates per cycle of IUI are:

7.4% for women under 35 years old
4.8% for women between 35 and 39 years old
2.2% for women between 40 and 42 years old
0.9% for women over 42 years old

The average cumulative pregnancy rates after six cycles of IUI are:

39.2% for women under 35 years old
29.1% for women between 35 and 39 years old
16.9% for women between 40 and 42 years old
8.5% for women over 42 years old

The average cumulative live birth rates after six cycles of IUI are:

35.4% for women under 35 years old
25.9% for women between 35 and 39 years old
14.8% for women between 40 and 42 years old
7.3% for women over 42 years old

These are only average rates, and they may vary from clinic to clinic, and from person to person. Your doctor will be able to give you a more personalized estimate of your chances of success with IUI, based on your specific situation and medical history.

What are the risks and complications of IUI?

IUI is a relatively safe and non-invasive procedure that has minimal risks and complications. However, as with any medical intervention, there are some possible side effects and drawbacks that you should be aware of before undergoing IUI. Some of the risks and complications of IUI are:

Infection: There is a small risk of introducing an infection into the uterus or the fallopian tubes during the IUI procedure, which can cause pelvic inflammatory disease (PID), a serious condition that can damage the reproductive organs and cause infertility, chronic pain, or ectopic pregnancy. The risk of infection is reduced by using sterile equipment and cleaning the cervix with an antiseptic solution before the procedure. If you experience any symptoms of infection, such as fever, chills, abdominal pain, or unusual vaginal discharge, you should contact your doctor immediately.

Bleeding or spotting: There may be some mild bleeding or spotting after the IUI procedure, which is normal and harmless. This is caused by the irritation of the cervix or the endometrium by the catheter or the sperm. The bleeding or spotting should stop within a day or two, and should not affect the chances of pregnancy. However, if the bleeding is heavy, prolonged, or accompanied by severe pain, you should contact your doctor immediately.

Multiple pregnancy: There is a risk of having a multiple pregnancy, such as twins, triplets, or more, if you use fertility drugs along with IUI. This is because fertility drugs can stimulate the ovaries to produce and release more than one egg, which can be fertilized by more than one sperm. Multiple pregnancy can increase the chances of complications, such as miscarriage, preterm labor, low birth weight, preeclampsia, gestational diabetes, and cesarean delivery. The risk of multiple pregnancy can be reduced by monitoring the number and size of the follicles with ultrasound, and by canceling or postponing the IUI procedure if there are too many or too large follicles.

Ovarian hyperstimulation syndrome (OHSS): This is a rare but serious condition that can occur if you use injectable fertility drugs along with IUI. This is when the ovaries become swollen and painful, and produce too many hormones and fluid. This can cause symptoms such as abdominal bloating, nausea, vomiting, diarrhea, weight gain, shortness of breath, and decreased urine output. In severe cases, OHSS can lead to blood clots, kidney failure, or ovarian torsion, which is a medical emergency that requires surgery. The risk of OHSS can be reduced by using the lowest effective dose of fertility drugs, and by monitoring the ovarian response with blood tests and ultrasound. If you experience any symptoms of OHSS, you should contact your doctor immediately.

Conclusion

IUI is a relatively simple and effective fertility treatment that can help many couples and individuals achieve their dream of having a baby. However, it is not suitable for everyone, and it does not guarantee success. Before undergoing IUI, you should consult with your doctor about your suitability, effectiveness, cost, and risks of the procedure, and weigh the pros and cons carefully. You should also set realistic expectations and be prepared for the possibility of needing more than one cycle or a different treatment option. With proper guidance and support, you can make the best decision for your family and your future.

I hope you find this blog post helpful and informative. If you have any questions or feedback, please let me know. Thank you for reading. 😊