IUI or AI is a fertility treatment that involves placing sperm inside a woman’s uterus to facilitate fertilisation. The goal of IUI is to increase the number of sperms that reach the Fallopian tubes and subsequently increase the chance of fertilisation. IUI provides the sperm an advantage by giving it a head start, but still requires a sperm to reach, penetrate and fertilise the egg on its own. It is a less invasive and less expensive option compared to In Vitro Fertilisation.

When IUI is used?

IUI or AI may be selected as a fertility treatment for any of the following conditions as well:

• Unexplained infertility
• Women with mild endometriosis
• Mild male factor infertility – sperm count not less than 5-20 million/ml
• A hostile cervical condition, including cervical mucus problems
• Cervical scar tissue from past procedures which may hinder the sperms’ ability to enter the uterus
• Lesbian couples
• A woman with a desire to be a single parent.
• Women whose partners have no spermatozoa or who need sperm of testicular origin to be used.
• Ejaculatory dysfunction

IUI is not recommended for the following patients mainly because they are associated with obstruction of the Fallopian tubes. IUI could be attempted if it has been definitively proven that at least one tube is open.

• Women who have severe disease and obstruction of both the Fallopian tubes
• Women with a history of pelvic infections
• Women with moderate to severe endometriosis

How IUI done?
IUI can be done in a spontaneous cycle (with spontaneous egg maturation) or with ovulation-stimulating medications. In both cases, careful ultrasound monitoring will be necessary to determine when the eggs are mature. A urine ovulation test can also be used if the patient is unable to get to her doctor for a scan. When the egg is confirmed to be mature, the doctor may suggest a trigger injection. This is to ensure that the mature follicle that houses the mature egg does rupture and release the egg into the Fallopian tube. The interval from seeing the mature follicle on scan/getting a positive urine ovulation test and giving the trigger injection to the egg arriving in the Fallopian tube is estimated to be around 36 hours later. In this time, any sperm deposited in the vagina will arrive in the tube and wait for the egg. When the egg actually enters the tube (ovulation), it will live here for two days. The IUI procedure will be performed around the time of ovulation, typically about 24-36 hours after the trigger injection. A single IUI is optimally done at this time although two inseminations may be done.

A semen sample – fresh or frozen – will be washed by the lab to separate the semen from the seminal fluid. A plastic catheter will then be used to insert the sperm directly into the uterus via the cervix using the instrument used for a Pap smear (a vaginal speculum). This procedure requires no anaesthetic or sedation and is essentially painless. Some patients may experience cramps in the hours following the procedure but this is in no way indicative of a poorer chance of success. The IUI process maximises the number of sperms that arrive in the Fallopian tube (which is where fertilisation occurs) thus increasing the possibility of conception.

The IUI procedure takes only a few minutes. Often, the lining of the womb is supported by medication for 12-14 days following the insemination. This medication will cause the body to mimic the signs and symptoms of pregnancy but a pregnancy has to be confirmed with a blood pregnancy test 12-14 days following the IUI.

What are the risks of IUI?
The chance of becoming pregnant with multiples is increased if you take fertility medication when having IUI. There is also a small risk of infection after IUI.

How successful is IUI?
The success of IUI depends on several factors; age being the most important. The success of the treatment cannot be assessed after one cycle but only after 4-6 cycles, as human beings have cumulative pregnancy rates i.e. the chances of falling pregnant increases the more times one tries. If a couple has the IUI procedure performed each month, success rates may reach as high as 20% after four cycles depending on variables such as female age, the reason for infertility, and whether fertility drugs were used, among other variables. While IUI is a less invasive and less expensive option, pregnancy rates from IUI are lower than those from IVF. If you think you may be interested in IUI, talk with your doctor to discuss your options.