IUI

An IUI — intrauterine insemination — is performed by threading a very thin flexible catheter through the cervix and injecting washed sperm directly into the uterus. The whole process doesn’t take very long — it usually only requires the insertion of a speculum and then the catheter, a process that maybe takes a couple of minutes (60-90 seconds to introduce the catheter, then sperm injection, and another 60 seconds or so to remove the catheter — going slowly helps reduce discomfort). Sometimes when the cervix is hard to reach a tenaculum is used to hold the cervix, which makes the process a bit more uncomfortable. A typical “Tomcat” catheter is shown below.

Usually the sample is collected through ejaculation into a sterile collection cup, but it is also possible to obtain collection condoms for this purpose (through the doctor’s office — Milex is one company that makes them). Most clinics want the semen to be delivered within a half hour of ejaculation, around the time of liquefaction, so if one lives close enough the sample can be collected at home. If not, one has to make do with a room at the clinic, a bathroom, or any private setting.

There is a delay between when the semen sample is dropped off for washing and when it is inseminated. The amount of time depends on the washing technique used, which takes 30 minutes to two hours, as well as on the clinic’s scheduling. Most will perform the IUI as soon after washing is completed as possible.

Ideally an IUI should be performed within 6 hours either side of ovulation — for male factor infertility some doctors believe after ovulation is better, otherwise chances of success are higher with insemination before ovulation with the sperm waiting for the egg. When timing is based on an hCG injection, the IUIs are usually done between 24 and 48 hours later. Typical timing would be to have a single IUI at about 36 hours post-hCG, though some do it at 24 hours, and some clinics are reporting better results when doing the IUI at 40-42 hours post-hCG. If two IUIs are scheduled, they are usually spaced at least 12 hours apart between 24 and 48 hours after the hCG. Some reports show no increase in success rates with two IUIs, but others suggest it may increase success as much as 6 percent.

Some doctors will base timing of IUI on a natural LH surge. In that case, a single IUI at 36 hours is the norm, but doing them at 24 hours is also pretty common since ovulation may be a bit earlier. When two inseminations are planned, they are usually timed between 12 and 48 hours after the surge is detected.

The egg is only viable for a maximum of 24 hours after it is released.

Searching through about a dozen medical journal articles and a number of web sites resulted in a rather wide range of statistics. Basically the odds of success are reported to be just under 6 percent and as high as 26 percent per cycle. The low statistics are with one follicle, while multiple follicles resulted in as high 26 percent success. Another influencing factor is sperm count. Higher sperm counts increase the odds of success; however, there was little difference between success with good-average counts and those with high counts. The overall success rate seems to be between 15-20 percent per cycle, judging from the articles which will be abstracted below. The rate of multiple gestation pregnancies is 23-30 percent.

Most women consider IUI to be fairly painless — along the same lines as having a pap smear. There can be some cramping afterward, but often what is felt is ovulation-related rather than from the IUI. The catheter usually doesn’t feel like much since the cervix is already slightly open for ovulation — a poorly timed IUI might cause more discomfort at the cervix. See the personal experiences below for more details.

Current research indicates that washed sperm can live 24-72 hours; however, it does lose potency after 24 hours. Another issue with IUI is that the sperm can keep on swimming beyond the fallopian tube, so the ideal window is really within 6-12 hours of the egg being released, with a larger margin before ovulation than after since the egg’s viability is shorter. Sperm can live up to 5 days in fertile mucus, 2-3 days being pretty common, so combining IUI with intercourse may provide better coverage.

You don’t have to lay down because the cervix doesn’t remain open, but most doctors let patients lay down on the table for 15-30 minutes after the procedure.

Most people don’t need to, but if you had cramping or don’t feel well afterward it makes sense to take it easy for awhile. Some people reduce their aerobic activity and heavy lifting during the luteal phase in hopes it will increase the chance of implantation. It is more important to take it easy for a bit after IVF, as that is a more invasive process.

This depends on your individual situation, but it usually should not be more than than 72 hours since his last ejaculation in order to ensure the best motility and morphology. Where low sperm count is the reason for IUI, it is generally best to wait 48 hours between ejaculation and collecting sperm for the IUI. With no sperm count issues, it makes sense to wait at least 24 hours. Some suggest trying for about 36 hours to cover the most territory with the highest counts — a common suggestion is to have intercourse around the time of hCG injection.

Usually you can have intercourse anytime after an IUI . . . in fact, most doctors suggest having intercourse, when that is an option, soon after the last IUI to help make sure ovulation is covered. Your doctor may suggest waiting 48 hours to resume relations if you had any bleeding during the IUI or if a tenaculum is used.

Once the sperm is injected into the uterus, it does not fall out. There can, however, be increased wetness after the procedure because of the catheter loosening mucus in the cervix and allowing it to flow out. Some doctors will insert a cup around the cervix to prevent leakage, but most do not.

The catheter loosens cervical mucus and lets it come out more easily. It is common to see more fertile mucus after an IUI for this reason, as well as the fact that well-timed IUI should be close to ovulation.

According to different studies, either 3-4 follicles gives one the best chance of getting pregnant, while more follicles beyond that simply increases the risk of multiples. The U.S. study said 4 follicles, while other countries have data stating 3. The U.S. has a higher rate of multiple births, so 3 may be more likely to be the correct answer.

IUI can help on Clomid cycles where cervical mucus is a problem, and IUI increases the chance of success on injectable cycles no matter what the sperm count. It does make sense to try IUI if you can and haven’t had success with intercourse. It is important to note that with intercourse, only the best and strongest sperm make it through the cervical mucus and up into the uterus and fallopian tubes. With IUI, more sperm will be available for fertilization.

A count above one million washed appears necessary for success, with a significant reduction in pregnancy rates when the inseminated is count is lower than 5-10 million (in other words, in most cases one should consider 5 million a lower limit for success, 10 million for cost-effective). Higher success rates are with washed counts over 20-30 million, while increasing counts over 50 million did not appear to offer advantage. Advanced Fertility has a chart of success rates for one month of various treatments.

It depends on what you can afford and what meds you are doing. One might do 3-4 IUIs on Clomid before moving on to injectables, then do 3-4 cycles on injectables. If one doesn’t have success after four good ovulatory cycles on injectables with well-timed IUI, it would be time to consider IVF.

An IUI shouldn’t be done at home without medical supervision because the sperm needs to be washed to prevent infection — i.e., separated from the semen. A vaginal insemination can be done at home, but is no more successful than intercourse. Some doctors are willing to instruct on doing ICI (intracervical insemination) at home, but it should not be attempted without being taught proper technique. Getting semen or air into the uterus could be quite dangerous — perhaps life-threatening. One woman wrote in to say there is a midwife practice in Berkeley, CA, that will do inseminations at the patient’s home, so it may be worth asking about.

It doesn’t usually happen, but it isn’t uncommon. It is most common to have some bleeding if the doctor had trouble reaching the cervix. Some women also have light bleeding with ovulation.

Implantation generally takes place 6-12 days after ovulation — so 6-12 days after a well-timed IUI. See abstract.

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There isn’t a clear-cut answer to this question. It will depend largely on your age and why you’re getting an IUI in the first place.

Actual data on IUI success rates are surprisingly hard to find, because studies include different patient populations, ages, infertility diagnoses, etc.

But we do know that while IUI is less invasive and less expensive than I.V.F., it tends to be less effective. Research suggests that women with unexplained infertility have about a 20-to-25-percent chance of getting pregnant over a few cycles. Women under 35 who choose to do IUI because they aren’t getting periods regularly can see success rates as high as 50 percent across three to six cycles, Dr. Brady said.

If you’ve tried the procedure three times with no luck, it’s best to have another conversation with your doctor, Dr. Brady added. At that point, it might be more efficient and cost-effective to move on to I.V.F.

Artificial insemination is a fertility treatment method used to deliver sperm directly to the cervix or uterus in the hopes of getting pregnant. Sometimes, these sperm are washed or “prepared” to increase the likelihood a woman will get pregnant.

Two chief approaches to artificial insemination exist: intrauterine insemination (IUI) and intracervical insemination (ICI). Some women may also take medications to stimulate ovarian follicle growth and increase conception chances.