An expert view on IUI
17th July 2018
In the second edition of our new blog series, we continue to breakdown the myths, medical jargon and statistics to give a comprehensive guide to treatments for infertility. This week we discuss IUI.
What is it?
Intrauterine insemination (IUI) is a medical procedure where a catheter is inserted in to the vagina and guided towards the uterus. A sperm sample is then inserted in to the catheter, leading it directly to the womb, aiming to get the sample as close to the released egg as possible.
Depending on your situation you may decide to use your partner’s sperm or donor sperm. If using your partner’s sperm, he will be asked to produce a sperm sample on the day of your IUI procedure. The sperm sample can be prepared in a number of different ways. Sperm washing is a common method where the sperm is ‘washed’ to create a concentrated sample of healthy, viable sperm. In cases where donor sperm is being used, the procedure is almost identical, but the sperm will have been collected previously, and frozen until the day it is required. This sperm will have been screened for diseases and tested to ensure it is viable.
It is important that IUI is timed so that the sperm reaches the egg at the right time. Ideally, IUI should be performed within a time period of 6 hours before or after ovulation. If you have a regular menstrual cycle, it is possible to work out the approximate time of ovulation yourself (it’s usually 12-16 days after your period). You can also use an ovulation prediction kit (OPK) to help accurately narrow down the window, and in some cases blood tests can be introduced. In some circumstances, medicines are prescribed to help stimulate the release of one or two eggs before the IUI procedure, this is known as stimulated IUI or superovulation with IUI. A cycle of stimulated IUI will be closely monitored with ultrasound scans, firstly to determine the timing of ovulation which helps to increase the chances of success, but also to reduce the risk of multiple pregnancy (twins, triplets or even more!)
Is it right for me?
IUI can be good option in a number of different circumstances. NHS funding for IUI is not the same across the UK, and is usually only offered to couples where vaginal intercourse cannot take place, either for physical or psychological reasons; or where there is a medical condition such as HIV which makes it unsafe to have unprotected sex. It is not routinely offered to other couples as the evidence shows that the success rates are not much better than regular sexual intercourse.
IUI may also be accessed privately. For female same-sex couples and single women who are wanting to have a baby, they will only be eligible for NHS funded IVF treatment if they have had 6 cycles of IUI in a clinical setting which has been unsuccessful. This IUI treatment would have to be self-funded.
Before you are able to proceed with IUI, you, and your partner’s fertility will need to be assessed, to ensure it is the right approach for you. If low sperm count, endometriosis, or damaged fallopian tubes is the cause of your infertility, it is unlikely IUI will be a successful treatment for you, but this should be discussed with your doctor.
What are the risks?
This is a fairly simple medical procedure and whilst the woman being inseminated may experience some discomfort, the serious risks are very minimal. It’s not uncommon to have some lower abdominal cramps, similar to period pains, for a day or so after the treatment, but most women have the procedure and then return to their day as usual. If you are taking fertility medications, such as Clomid, Letrozole, and hMG to improve the success rate of IUI, these can come with their own side effects, including headaches, fatigue and effected mood due to the change in hormones, as well as the potential risks of multiple pregnancy and ovarian hyperstimulation syndrome.
How successful is it?
Whilst less expensive and less invasive than IVF, treatment with IUI is less successful. As with all fertility treatments, the age of the woman will have a significant impact on the success rate of IUI. Your doctor will also take into account the length of time you have been trying to get pregnant, as well as the underlying reason for subfertility and work with you to decide if IUI is the best treatment for you. The average couple has a 20% chance of getting pregnant with each menstrual cycle, but after one year of trying the chance of conceiving in any given cycle will have fallen to 1.5-3%. In this situation it is important that any treatment offered can give better odds than this.
Frozen sperm has been proven to be less successful than fresh sperm, which is something to consider, especially if you are using donor sperm. You can increase the chances of conceiving by IUI by taking medication (eg. clomiphene) to stimulate ovulation and trying to monitor your cycle carefully so you have the procedure at the optimal time for fertilisation.