Intrauterine Insemination

Formerly known as artificial insemination, intrauterine insemination (IUI) is a procedure that involves the deposit of a man's sperm into a woman's uterus in hopes of increasing the chances of fertilization. IUI now falls under the general category of artificial insemination next to three other treatments: intracervical insemination (ICI), intratubal insemination (ITI) and intrafollicular insemination (IFI).

Of all four artificial insemination procedures, IUI is by far the most common. Because it does not involve the manipulation of your eggs, it is not considered an assisted reproductive technology (ART) procedure. You might choose IUI over a more invasive procedure like in vitro fertilization (IVF) because it is more affordable and less stressful on the body.

Procedure

The IUI procedure itself is short, simple and fairly painless. Your ovaries normally release just one egg a month, so your doctor may first prescribe a fertility dug, like Clomid, for you to take near the beginning of your menstrual cycle prior to ovulation. This will help stimulate your ovaries to develop several mature eggs instead of just one, which will improve your odds of becoming pregnant.

Next, your doctor will likely perform an ultrasound to determine where you are in your cycle and when to conduct your IUI. Once you begin ovulating, a sperm sample (either from your partner or a donor) will be prepared for insemination using a process known as sperm washing. This process takes about one hour, during which time the sperm cells are separated from the seminal fluid and placed in a solution of nutrients that may enhance the sperm's motility and increase their chances of survival, hopefully resulting in a fertilized egg.

Once the sperm are washed, they are deposited into your uterus through your cervix using a small, flexible catheter. Bypassing natural barriers and placing the sperm directly into your uterus gives the fertilization process a bit of a head-start. The procedure does not require anesthesia and should not take more than a few minutes.

Discomfort, if any, is similar to that felt during a Pap smear and may include some cramping following the procedure. Many times, this cramping is ovulation-related and not a direct result of IUI. You probably won't feel the catheter because your cervix is already slightly open due to ovulation.

Your doctor will inform you of any resting period following IUI, as well as how long you and your partner should abstain from intercourse both before and after the procedure. Because implantation can occur anywhere from six to 12 days after ovulation, you should wait about two weeks before taking a pregnancy test to see if the insemination was a success.

IUI is safe and can be repeated numerous times. Because it is much less expensive than other fertility treatments, such as IVF, many women undergo as many as three to six cycles of IUI before getting pregnant or trying another form of treatment.

Good candidates for IUI

IUI might be a good treatment choice for you and your partner if you have been trying unsuccessfully to conceive for at least one year and the reason for your infertility is unknown. IUI may also be an option for women with poor cervical conditions, such as very thick cervical mucus, or for couples who have been diagnosed with a sexual dysfunction.

The sperm used in your IUI can come from your partner or from a donor; it depends on the health of your partner's sperm and what you have both decided. Of those who use a donor, many prefer to use sperm provided by someone they know personally, while others choose to use a sample provided by an anonymous donor. As many as one in eight infertile couples turn to donor insemination in order to conceive. Some people who commonly choose donor sperm include single women, same-sex couples, men with no sperm, low sperm counts or poor sperm motility, or if the man has an infection or genetic defect that could be passed on to a child.

IUI should not be used in women with blocked fallopian tubes or in women over 40.

Risks

One of the greatest benefits of IUI is that it allows for fertilization to occur naturally inside your body. It is one of the least stressful fertility treatments on the body, especially if there are no fertility drugs taken, and it imposes very few associated risks.

You may experience some cramping or spotting during or following the procedure, and there is a chance you could develop an infection, including STDs, if the sperm has not been properly screened. The risks that come with fertility drugs, such as breast and uterine cancers, are specific to particular types of medications.

Success Rates

IUI success rates depend on your age and your health, as well as the health of your partner's (or donor's) sperm. Younger women usually have greater success than women over the age of 35. Sperm count also greatly affects the outcome of IUI procedures. As with natural fertility, the higher the sperm count, the higher the success rates.

When no fertility drugs are used, the success rate of IUI is as low as 6 percent. With fertility drugs, however, your body produces several mature eggs rather than just one, increasing your chance of getting pregnant to nearly 30 percent. On average, the success rate associated with IUI is 15 to 20 percent in one cycle.

When repeated insemination procedures don't work, IVF is usually the next step in fertility treatment. Although it is much more costly and invasive, it has much higher rates of success per cycle.

Cost

The cost of one cycle of IUI may vary from fertility clinic to fertility clinic, and will depend on where you live and whether you use your partner's sperm or a donor's. If you use your partner's sperm, the average cost of IUI is between $300 and $700 for each cycle; donor sperm costs a bit more. There may also be extra costs for fertility medications, ultrasounds and blood work.