What is intrauterine insemination (IUI)?
Intrauterine insemination (IUI), publicly known as insemination is a procedure in which the sperm cells selected from the semen sample taken from the male partner generally by masturbation in the IVF Center is placed directly in the woman's vagina, cervix, or uterus around the time of ovulation after subjected the semen sample to some procedures. The aim of IUI is to bypass the cervix, where most of the sperms are eliminated, and place a high number of motile sperm directly into the top of the uterus as close to the oocyte as possible by using a small, flexible plastic catheter.
In what cases is Intrauterine Insemination (IUI) recommended?
- Infertility associated with low sperm count and decreased sperm motility
- Infertility associated with erectile dysfunction or ejaculation dysfunction
- Fertility associated with retrograde (semen enters the bladder instead of ejaculating through the penis during orgasm
- Infertility associated with cervical problems
- Unexplained infertility (This group constitutes the majority of IUI apps)
- Infertility associated with mild or moderate endometriosis
To ensure fertilization via IUI, it is required that the ovaries are stimulated to produce quality eggs and at least one of the tubes isn't obstructed and sperm size and shape, sperm count, and sperm motility are appropriate to fertilize the egg in the tube.
In what cases IUI is not recommended?
- Congenital cervical atresia (Congenital closure of cervix)
- Cervical and intrauterine inflammation conditions such as cervicitis, endometritis
- Bilateral tubal obstruction
- Female age over 35
- Ovulating 3 or more eggs after ovarian stimulation
Insemination (IUI) Treatment Steps
- Ovulation induction (ovarian stimulation) and monitoring the egg development
Pills or injections are administrated externally to stimulate the development of follicles. Rarely, the ovum formed spontaneously without medication in the menstrual cycle of the woman can be used. Egg development in the follicles is monitored by ultrasonography and hormone analyses. Ultrasonography helps to track the size of the follicle which contains the egg cell. Monitoring the size of the egg cell is very important for treatment. The reason for this is that the maturity of an egg in the follicle is closely associated with the follicular size; on average, the ideal follicular size for hatching is 18 to 20 millimeters. Estrogen and LH hormone levels, which have distinguished roles in ovulation, are measured by hormone analysis. An increase in estrogen hormone levels indicates healthy follicle development. On the other hand, the luteinizing hormone (LH) increases significantly during the ovulation period and stimulates the follicle to release the egg that matured. When the egg is released, the fallopian tube catches it to transport it to the uterus. The sperm cell successfully meets the egg in the tube and fertilizes it. An unexpected increase in the luteinizing hormone (LH) may cause the egg to hatch earlier resulting in delaying the administration of the intrauterine insemination.Considering this fact, measuring the levels of these hormones is of great importance. - Determining the Time of Ovulation
During the monitoring process, a patient may require several ultrasounds and hormonal tests to monitor the development and pace of follicle growth. Once the follicle containing the egg cell measures at least 18 to 20 millimeters in diameter, an injection of human chorionic gonadotropin (hCG) is administrated to trigger the egg hatch. Insemination is carried out 32-36 hours after the hCG shot. - Insemination Time
A semen sample is taken from the male partner by masturbation at the IVF center 1-2 hours before the time that the insemination takes place. The semen sample is subjected to a series of procedures to select the healthy and most motile sperm cells which have the highest probability to fertilize the egg. Subsequently, the sperm cells that are most likely to fertilize the egg cell are separated and placed in a plastic cannula called a catheter. Meanwhile, the expectant mother is prepared for the procedure on the gynecological table in the IVF center. For convenience, a vaginal speculum is inserted to keep the vaginal walls apart. Then, the uterus is reached by passing through the cervical canal with the catheter containing the sperm cells, and the sperm cells are injected into the uterus.Intrauterine insemination, which is a painless procedure that requires no anesthesia, takes an average of 10-15 minutes. Following the procedure, the patient is allowed to lie on her back with her knees bent for at least 10 minutes. After this short rest, the patient can go home and continue her daily life. A blood pregnancy test is performed 12 days after the insemination. - Multiple pregnancies: Multiple pregnancies are one of the outstanding risks of IUI treatment. Fertility medications used to stimulate the development of follicles in the ovaries can result in the production of multiple eggs leading to multiple gestations.
- Infection: In order to prevent this, the process must be carried out under sterile conditions and in an appropriate environment.
- Do not use pain killers around the time of ovulation unless necessary. The use of pain killers around the time of ovulation affects ovulation negatively.
- Couples can have sex during the treatment process.
- If you regularly use any medication, please inform your doctor at the beginning of your treatment. Do not use any medication without your doctor's knowledge. Avoid being exposed to radiation (X-ray, etc).
- Risks of the Treatment
Success Rate
The chance of achieving pregnancy with one IUI cycle is around 11-17%. This rate is 14-17% when donor sperm is used. If the male partner's sperm count is within normal limits and the woman's tubes are healthy, the chance of gestating may reach up to 50% after a few cycles within a year. If pregnancy can't be achieved after trying 3-4 intrauterine insemination (IUI) cycles, In Vitro Fertilization (IVF) is recommended as an alternative.
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