IUI
Intrauterine insemination (IUI) is a simple form of fertility treatment that involves directly placing a specially prepared and washed sperm inside a woman’s womb, close to the time of ovulation.
It is a straightforward, non-invasive procedure very similar to a smear (Pap) test, which is usually easy and painless and lasts for just a few minutes. No sedation or painkillers are required.
The procedure involves the insertion of a speculum into the vagina in the same as way as having a cervical smear test. A thin, soft catheter (tube) is then passed through the cervix into the womb. A properly processed sperm sample, containing the best quality sperm, is injected via the catheter.
Optimum timing and healthy sperm increase the chances of IUI success.
Typically, IUI is performed just before the ovulation. This ensures that the sperm are close to where they need to be, at the most fertile point of the menstrual cycle, hence increasing the chances of conception.
The sperm used in IUI is carefully washed and prepared in the laboratory. The weaker, sluggish or non-moving sperm are separated from the stronger, healthier, fast-moving sperm and toxins are removed.
IUI can be carried out within a woman’s natural menstrual cycle, without using any fertility drugs (natural IUI).
However, fertility drugs may be administered to stimulate egg production and ovulation, and to prepare the uterus to receive embryos (stimulated IUI).
If 3 to 6 consecutive cycles of IUI have been performed without being successful, then review of the treatment plan is needed and consideration should be given, moving to more invasive fertility treatments such as in vitro fertilisation (IVF).
The first step is to have an initial medical consultation to assess your condition and agree your personalised treatment plan, which will give you the best chance of success.
Once it has been agreed that IUI is the most suitable treatment for you, the next step would be to decide whether your treatment would be a natural without using any fertility drugs or a stimulated with use of fertility drugs cycle.
During the process, you will need to have 2 or 3 ultrasound scans and blood tests to monitor the growth of your follicles and track ovulation. Depending on the number and size of your follicles, the thickness of the lining of your womb and the results of the blood tests, the decision will be made regarding the appropriate time for insemination.
You may be asked to carry out testing yourself using at home an ovulation predictor kit to detect the hormone “LH surge” that signals ovulation.
If required, ovulation will be triggered with an injection of the hormone human Chorionic Gonadotrophin (hCG), in order to mimic the action of the “LH surge” and stimulate the release of the egg. The advantage of using the trigger injection is timing the release of the egg and planning the insemination.
The sperm will be inserted 24 to 36 hours after the ovulation trigger or the “LH surge”.
Your partner is most welcome to attend with you whilst you are having your scans. If you are having treatment using your partner’s sperm, on the day of the insemination he will be asked to produce a semen sample.
Through out the procedure a very strict witnessing protocol is followed, with double witnessing at all levels to ensure that the right sperm is inseminated in the right patient.
Following the procedure, it is recommended to rest for approximately15-20 minutes before going back home.
You will be advised to take a pregnancy test two weeks after your IUI treatment.
Following a positive pregnancy test an ultrasound scan needs be performed approximately 3 weeks later.
If negative you will be offered a follow up consultation, to review the situation and plan the way forward.
The idea behind IUI is that couples experiencing difficulty to get pregnant can benefit from the exact timing and placement of a more potent and healthier sperm inside the womb.
IUI is ideal for women who have a good egg reserve, open fallopian tubes, are under 35 and wish to try a less invasive treatment before embarking into IVF.
It is particularly appropriate for single women and same sex couples, who need only donor sperm to conceive.
IUI may also be offered to improve the chance of conception in cases when there is a mild male factor problem, with mild reduction in the sperm count and motility. However, it is not appropriate for cases when the sperm quality is poor.
The treatment can also be helpful when there is a difficulty from the male partner to ejaculate during intercourse.
It can be of particular benefit for women with irregular periods who experience difficulty tracking down the ovulation time and therefore synchronizing intercourse with ovulation.
Treatment with IUI is not recommended in cases where the fallopian tubes are blocked or damaged.
It is important to note that IUI does not have high success rates when compared to IVF. Hence it may not be the best option for many patients. Each individual situation needs to be assessed to ensure whether IUI is the appropriate option.
The fallopian tubes should be open and healthy and there should be no adhesions present that might prevent an egg from having access to either tube. Therefore the patency of the tubes is a prerequisite before proceeding with intrauterine insemination.
The test most commonly used to assess the patency of the tubes is the Hysterosalpingogram (HSG), which is an X-ray test involving injecting a dye through the cervix.
Alternatively Hysterosalpingo-contrast-sonography (HyCoSy), a simple and well-tolerated outpatient ultrasound procedure can be considered.
The gold standard method for assessing the patency of the tubes is a laparoscopy and dye test. However this is an invasive surgical procedure under anaesthetic, hence not favourable in many cases.
A baseline ultrasound scan to exclude the presence of any ovarian cysts and establish the integrity of the lining of the womb (endometrium) is strongly advised.
The presence of any benign uterine growths such as polyps or fibroids and/ or the presence of any uterine anomalies such as an endometrial septum needs to be excluded before embarking onto a fertility treatment.
If any of the above findings are present then a decision needs to be made whether a surgical procedure, hysteroscopy or laparoscopy would be recommended, before starting an IUI treatment.
What tests you need to do?
For you, the following tests are required:
- Anti-Mullerian Hormone (AMH)- (within 1 year of treatment)
- A full hormone profile done between the 2nd – 3rd day of your period (within 1 year of treatment). That would include the following hormones: FSH, LH, Oestradiol (E2) and Prolactin
- Blood group and Rhesus status
- Haemoglobin electrophoresis, to exclude carriers of thalasaemia or sickle cell disease
- Rubella IgG, to check for immunity to Rubella
- CMV (cytomegalovirus)- only if you are using a sperm donor
- FBC (within 2 months of treatment)
- Thyroid stimulating hormone (TSH) (within 2 months of treatment)
- Vitamin D (within 2 months of treatment)
- Chlamydia test (within 2 years of treatment)
- Cervical smear (Pap- test)- in line with national screening guidelines
- Mammogram – if aged 40 years or above – In view of the increased prevalence of breast disease we would recommend screening prior to commencing a treatment (unless one has been performed within the last 3 years).
Furthermore the following blood tests are mandatory for you and need to be done within 6 months of the treatment:
- HIV
- Hepatitis B surface antigen (HBsAg)
- Hepatitis C (Anti-HCV)
- Syphilis
If you have a male partner/ husband using his own sperm he will need to have the following tests:
- Blood group and Rhesus status
- Haemoglobin electrophoresis, to exclude carriers of thalasaemia or sickle cell disease
- Semen Analysis & Sperm culture (within 12 months of treatment). This is essential as poor sperm quality is a contra-indication to this type of fertility treatment.
Furthermore the following blood tests are mandatory for him and need to be done within 6 months of the treatment:
- HIV
- Hepatitis B surface antigen (HBsAg)
- Hepatitis C (Anti-HCV)
- Syphilis
BE AWARE THAT FURTHER TESTING MAY BE ADVISED BASED ON YOUR HISTORY
Safe
IUI can be carried out within a woman’s natural menstrual cycle and, unlike conventional IVF, without the need for intensive medication.
The lack of fertility drugs and invasive procedures means that IUI is a very safe form of assisted reproduction treatment, which avoids the potential side effects associated with some forms of IVF, hence making it an excellent option for many women.
Non-invasive
In IUI there is no egg collection involved, meaning that there is no invasive procedure. Furthermore the procedure is painless and no sedation or anaesthetic is needed.
Affordable
IUI is a relatively affordable fertility treatment, and many individuals or couples will opt to try IUI before moving forward with the more intensive and expensive IVF process.
Good for single women & lesbian couples
IUI is ideal for women who have a good ovarian reserve and open fallopian tubes. Hence, it is often most used by single women and same-sex couples, who need only donor sperm to conceive.
Acknowledging the benefits of IUI, including the lower cost, the lower time commitment, and the lower stress, helps appreciating why many individuals and couples consider trying IUI as the first option.
IUI is a straightforward, non-invasive procedure, which is generally easy and painless. However, occasionally, some women may experience temporary, menstrual-like cramping.
In a stimulated IUI multiple big size follicles may develop as a result of the medication, which is being used. That would be accountable for the most significant risk associated with stimulated IUI, which is the risk of multiple pregnancies.
Therefore if there are several mature follicles growing on the scan monitoring, it is advisable to abandon this treatment cycle.
The IUI success rates vary depending on the woman’s age at the time of treatment.
The clinical pregnancy rate in women below the age of 35 is between 10-15% per attempt.
This drops to approximately 8-10% for women aged between 35-40 and it further drops to below 5% in women above the age of 40.
For the vast majority of women over 40, it would be advisable to move straight to in vitro fertilization (IVF).
Whether requiring donor sperm due to significant male factor fertility problems, or as a woman with no male partner we will give you all the information you need to help you find a suitable donor and source the donor sperm. You need to take into consideration that according to Greek Law, sperm donation is strictly anonymous.
We collaborate with the most reputable International and Greek sperm banks and we are confident that the highest standards are met regarding the safety and the selection of their donors.
Once you have chosen a donor, the sperm will arrive to us within a week and your treatment can start.
A counselling session for everyone using donor sperm is highly recommended. An open discussion about the implications of the treatment can give answers to your questions and help you deal with any concerns or fears you may have. You should always remember that the ultimate decision is yours.