Intrauterine Insemination (IUI)

Intrauterine insemination (IUI) may be one of the oldest fertility procedures on record and might have been used by Arabian horse traders, in prize horses, as early as the 1300's. Success in dogs and some amphibians was reported in the late 1700's as was the first successful human artificial insemination. Little additional work was done with the procedure until the late 1800's."Unwashed" or "unprepared" sperm must never be placed in the uterus as serious, sometimes fatal, allergic reactions can occur. The insemination bypasses the cervical mucus and is therefore a treatment of choice when antisperm antibodies are present. IUI may also indicated in mild male factor infertility.

IUI involves placing specially concentrated and washed sperm from the husband, or a sperm donor, directly into the anovulatory women who have failed three cycles of Clomid and timed sexual intercourse.

The advent of IVF with ICSI makes it possible for men with as few as one, or no, sperm in their ejaculate to father genetically related children. Undoubtedly, the popularity of IVF/ICSI has reduced the number of "donor sperm" conceptions. The major advantage of using a sperm donor, compared to IVF/ICSI, is that donor sperm insemination is significantly less expensive.

Most IUI cycles, conducted by reproductive specialists, are "stimulated" meaning that the patient receives ovulation inducing drugs, such as FSH. These medications stimulate the development of the ovarian follicles each of which contains an egg. Once the eggs mature, an injection of hCG is given to stimulate ovulation 36 hours later. We schedule a single precisely timed insemination around the time of ovulation or shortly thereafter. Patients are monitored throughout the stimulation with ultrasound and estradiol measurements, and physical examination.

Two of the major potential side effects of stimulated IUI cycles are 1) the potential for high order (>2) multiple births and 2) ovarian hyperstimulation syndrome. A non-specialist should probably not administer injectable infertility drugs in association with IUI. Rather, a reproductive endocrinologist/infertility specialist must carefully monitor these patients in order to keep all complications at an acceptably low rate.

The couple returns to the office for the insemination based upon the timing of the hCG injection. Upon arrival a sperm sample is collected from the partner or frozen sperm from a donor is prepared. Carefully prepared semen is then inserted directly into the uterus using a small catheter in a painless procedure.

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