Infertility Treatments
Artificial/Intrauterine Insemination
What is Artificial Insemination?
Artificial insemination involves the placement of sperm into a woman’s vagina, cervix or uterus by means other than intercourse. The most common type of artificial insemination is Intrauterine Insemination (IUI). The second most common form is Intracervical Insemination (ICI).
For many couples, artificial insemination therapy alone is not adequate. Artificial insemination is usually performed in conjunction with fertility medications such as clomiphene or gonadotropins to further enhance fertility.
How do IUI and ICI differ?
IUI is a procedure performed in the physician office and allows for sperm to be placed directly into the uterus. First, sperm is obtained from the male partner, or donor. The sperm is then counted, washed, concentrated and placed into a small syringe. A small tube (catheter) is attached to the syringe. The catheter is then placed through the cervix and into the lower part of the uterus. The sperm is deposited directly into the uterus.
The advantage of IUI is that sperm become more active when they are washed and many more sperm reach the egg as compared to routine intercourse. Since IUI by-passes the cervix, it is a treatment to overcome the effects of antisperm antibodies or thick cervical mucus.
With ICI, the man’s ejaculate (sperm and semen) is placed into a small flexible rubber cup which is inserted into the vagina.
ICI, or intracervical insemination, does not deliver as much sperm to the egg as does IUI. Sperm used in ICI does not require as much preparation and this procedure can often be performed in the privacy of a patient’s own home. The downside to ICI is that pregnancy rates are lower than with IUI.
Who is a candidate for artificial insemination?
To have either procedure performed, a woman must have fallopian tubes which are open. Women with blocked tubes are not candidates for IUI or ICI.
Which should I choose?
Most couples will choose IUI because pregnancy rates are higher. IUI is a good treatment for couples with unexplained infertility (with the use of medications to improve ovulation), and males with slightly low sperm counts or motility.
ICI is most appropriate for couples who cannot have intercourse due to physical incompatibility and for women who do not have a male partner.
How long does it take?
After the man provides a semen sample, it takes about 1 hour to process the sperm. On rare occasion sperm processing takes longer, depending on the man’s sperm.
The IUI takes only a few minutes. We ask you to lie still for about 10 minutes after the procedure. Overall, the process usually takes 1 ½ hours. If necessary, the male partner and female partner can arrive and depart at separate times.
Processing frozen/donor sperm takes about 45 minutes.
How likely am I to get pregnant?
The absolute success rate depends on your age, the conditions contributing to infertility, what medicines you are taking to enhance your fertility (e.g. clomiphene or gonadotropins) and the sperm count in the specimen.
In general, IUI doubles the pregnancy rates seen obtained with intercourse (though these rates vary depending on the cause of the infertility). Couples who have multiple reasons for not being pregnant are less likely to achieve a pregnancy.
Your physician will try to estimate your success rates based on your history and should be able to give you an idea of how likely you are to be successful with artificial insemination.
How many times should I do IUI?
We will typically recommend 3 IUIs before regrouping with your physician. After each IUI, your physician will review your chart to see if any changes in medication or treatment plan should be considered.
Couples who have not conceived after 6 IUIs are much less likely to succeed with further attempts with IUI.
What tests do I need?
Requirements for IUI include cervical cultures for Chlamydia and Gonorrhea; normal pap smear in the past year; Hepatitis B, C, HIV, syphilis (RPR) and cytomegalovirus (CMV) testing, and blood type and screen.
Men providing a semen specimen for IUI must be tested for infectious diseases: HIV, Syphilis, Hepatitis B, and Hepatitis C and CMV.
How do I know this is my partner’s sperm?
This is a common question among patients, even if they don’t ask out loud.
When you arrive in clinic, an IUI order form is generated and it will have your name on it, as well as a numbered code. This order form is given to the lab and a specimen cup is labeled with your numbered code. After your partner returns the sample, it is transferred into a syringe labeled with your name, your partner’s name and your code.
You must identify all three as correct prior to having the IUI performed.
How do I know this is the correct donor’s sperm?
As with correctly identifying a partner’s sperm above, we will label your sperm sample with your name and your code. You must identify both correctly prior to having the IUI performed.
What are the risks of IUI and ICI?
IUI complications are rare. Mild cramping is not uncommon during the procedure but this usually resolves within 15-20 minutes. The risk of infection is extremely small. Less than 1% of women ever have a significant problem after IUI.
Call us if you develop severe abdominal or pelvic pain, fever or chills within three days after this procedure.
How do I schedule IUI or ICI?
If you are attempting a natural cycle (spontaneous ovulation without medications) or using oral ovulation medications, there are two ways to schedule IUI/ICI:
- Using ovulation predictor kits (OPKs). This is mainly used with clomiphene or other oral ovulation induction agents. The woman calls us the day her kit turns positive (423-876-2229). Since most women ovulate 12-36 hours later, the IUI/ICI is scheduled the next day.
- Using hCG injections. hCG will induce ovulation in women who have mature egg follicles. Ovulation occurs approximately 36 hours after the hCG injection and that is when we would schedule the IUI/ICI.
For women who can reliably detect their own ovulation, studies have shown that the two timing strategies are equally effective. The advantage of using OPKs is lower cost; the disadvantage is that the tests are imperfect and may not always detect ovulation, causing frustration and delayed treatment.
Using hCG requires 1-2 ultrasounds, plus the cost of the injection.
What are the costs?
Sperm preparation and IUI typically cost around $530.
Use of donor sperm involves additional costs of purchasing and shipping the sperm from a sperm bank to TRM, which is approximately variable, depending on where the sperm originates.
In some cases, a complex sperm preparation is needed to isolate more viable (living), motile (swimming) sperm. This can add a small fee to the cost of the IUI preparation.
The service must be paid prior to the procedure.