Intrauterine Insemination (IUI)
Intrauterine insemination (IUI) is a technique that increases the number of sperm that get to the egg. With intercourse, the sperm is deposited in the vagina. The sperm must then swim into the cervical mucus. From there, it must get through the mucus and into the uterus. It is likely that 99% of the sperm in the vagina never makes it into the uterus. From the uterus, the sperm swims into the tube were the egg is waiting to be fertilized.
To do IUI you must have sperm, eggs, and at least one open tube. You cannot do IUI if your tubes have been tied.
Reasons to consider IUI
- Low sperm count
- Failure to conceive with intercourse during the first 3 months of treatment for fertility with clomiphene citrate or letrozole/Femara
- Poor cervical mucus. This is a common occurrence when taking clomiphene citrate
- Unexplained infertility
- IUI is almost always done when fertility injections are done. This is an economic consideration in that the injectable mediations are so expensive we feel that we should do anything that increases the pregnancy rate with the treatment.
The Importance of Proper Semen Preparation for IUI
There are two types of labs processing semen for IUI, IVF/fertility labs and the gynecologist’s office. In the gynecologist’s office, the specimens are usually processed by someone with minimal training utilizing centrifuges that are usually used to spin urine samples. This is considered a “dosing” procedure and is therefore not covered by any government regulations. There are no required government inspections and no accountability to higher authority. IVF labs are covered under FDA (Food and Drug Administration) regulations. They are also required to report IVF results to the CDC (Centers for Disease Control). Most IVF labs are members of SART (Society of Assisted Reproductive Technology). Part of the requirement for SART memberships is onsite inspection by CAP (College of American Pathologists) or Joint Commission (JC). The inspections by FDA, CAP, SART, and JC cover the part of the lab processing sperm for IVF and IUI. In addition, the head of these labs must be qualified as a HCLD (High Complexity Lab Director). Each person processing laboratory samples must be trained to standards.
So, you have the choice, you can have your samples processed by someone in your gynecologist’s office who has no specific training to do so with no one inspecting the system, or it can be processed in an IVF/fertility lab were everyone has specific training and testing with inspections by the CDC, FDA, CAP, and JC.
You cannot place semen into the uterus without processing it. There are chemicals in semen that cause severe cramping of the uterus if not washed out. There are also relatively large amounts of bacteria. Most specialty fertility/IVF labs use what are known as density columns to remove the greatest number of bacteria, inflammatory cells, and bad sperm. Most gynecologists don’t know about these density columns. Pregnancy rates are clearly better with these and in some cases the miscarriage rate is also lower after using columns. In our labs, we use special centrifuges that allow us to dial in the exact gravitational force applied to the sperm. Urine centrifuges may apply more than twice the optimal force. It has been shown that these excessive forces damages sperm which is why we use machines that allow us to use lower forces. It is adequate to separate the good sperm from things we don’t want in the uterus and tubes but will not damage the good sperm.
The Importance of Proper Catheters
IUI should cause minimal to no discomfort. Experience and proper equipment is key. We frequently have patients tell us that they had a bad experience with an insemination elsewhere. Usually this is cramping. This is primarily due to inexperience in some offices and an assumption in most fertility centers that it can’t be made better. With over 30 years’ experience in infertility treatment and experience with hundreds of products, we know the manufacturer of the best IUI catheter in the world. They do not have a US distributor so we import these ourselves. The company has approval from the FDA for sale and use of their device in the US. Other clinics do not use this catheter because it cost 3 to 4 times more than those available in the US and it takes more effort to obtain them. Our patients think it is well worth the extra trouble and expense.
Cost of IUI
Our cost for IUI is substantially lower than the other local IVF centers and less than most gynecology offices.
There are too many factors influencing success with IUI to give blanket success rates. The two most important factors are woman’s age and number of sperm available. Fertility rates also drop significantly after 3 failed IUI cycles.