What is Intra-Uterine Insemination (IUI)?

IUI is one of the simplest forms of assisted reproduction, as there is no removal of eggs and no fertilisation in the laboratory. Sperm from the male partner, or a donor, is simply introduced into the uterus via a catheter and left to fertilise the egg or eggs naturally.

IUI is an ideal treatment for couples who produce healthy eggs and sperm, but who experience problems in conceiving through intercourse due to disability, injury, erectile or ejaculation problems. IUI using donor sperm can provide a route to conception for couples where the male produces no sperm at all, for single women, or women in same sex relationships.

This article is written by Jackie Griffiths, a freelance journalist who writes health, medical, biological, and pharmaceutical articles for national and international journals, newsletters and web sites. 

Who can benefit from IUI? 

IUI can help overcome many infertility issues for both men and women, including:

• Ovulatory disorders
• Low sperm mobility or low sperm count
• Hostile or thin cervical mucus
• Other problems with traditional conception such as physical disability

IUI can also help women with endometriosis, as long as this has not affected the workings of the fallopian tubes.

For many couples with unexplained infertility, IUI is the first step in their fertility treatment as it is relatively inexpensive and provides the closest thing to a natural conception. However, the success of the procedure is only around half that of IVF, with a pregnancy rate of around 15% per cycle. This will naturally vary with factors such as age, the quality of the eggs and sperm, and the nature of the original problem.

The IUI Procedure 

The exact IUI treatment given will depend on the nature of the problem, and both partners are recommended to undergo a full fertility check beforehand to ensure the most effective treatment is undertaken. IUI can be used in conjunction with natural or stimulated ovulation, with multiple egg production recommended for couples where the male has a low sperm count or low mobility sperm.

• Natural IUI – this is the simplest form, with the woman’s natural cycle closely monitored and the sperm introduced at the appropriate time. If the problem is an external physical one, this may be all that is required.
• IUI with Clomiphene Citrate – in cases where the woman does not ovulate on her own or does not ovulate regularly, a tablet is used to produce ovulation. This drug stimulates the pituitary gland to produce the hormone which in turn stimulates ovaries to produce one or occasionally two eggs.
• IUI with Gonadotrophins – where there is a low sperm count or low mobility, a course of hormone injections are used to directly stimulate the ovaries to produce multiple eggs, to increase the chances of conception.
• IUI with GnRH Agonists – in some cases where ovarian stimulation is required, a course of synthetic hormone injections are used first to suppress the natural menstrual cycle, in preparation for treatment with Gonadotrophins.  

Possible Complications 

Given the relative lack of sophistication of the treatment, there are many factors which can prevent it resulting in a successful pregnancy, including:

• Excessive ovarian response - this may prevent the eggs maturing properly or may present an unacceptable risk of producing multiple successful embryos. In this circumstance, no insemination will take place.
• Unresponsive ovaries – sometimes the ovaries do not respond to chemical stimulation and so insemination is not recommended.
• Lack of sperm sample – the male partner may not be able to produce the required sample at the time it is needed.
• Lack of fertilisation or implantation – just as in natural conception, there are no guarantees that the eggs present will become fertilised or that the embryos will successfully implant.

There are very few health risks associated with natural IUI where no extra drugs are involved. However, if the ovaries are artificially stimulated to produce more than one egg, then she may experience problems with over stimulation (OHSS) and could be exposed to the risks associated with multiple births.

Costs  

Because the treatment is generally simple and straightforward, IUI is relatively inexpensive. A cycle of private IUI treatment will cost around £500- £1,000, depending on which drugs are required during treatment.

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