Intrauterine
Insemination
Intrauterine
insemination, or IUI, is one of a number of treatment techniques that
your GYFT physician may recommend depending on your medical history.
IUI involves depositing laboratory-prepared sperm into the uterus in
order to increase the number of sperm at the site of fertilization in
the fallopian tubes. IUI may also be used in conjunction with one or
more fertility medications (see Ovulation
Induction) in order to enhance follicular
development.
Albeit more
sophisticated and definitely less romantic than timed intercourse at
home, it is very commonly and effectively used to create pregnancies in
couples with unknown or minor infertility. This requires that the woman
must be able to ovulate, have normal tubes, have a normal uterine
cavity, and the male must have reasonable sperm function. Wait, we can
hear you already: "So what kind of help is IUI, then? If I had all that
going for me, I’d be pregnant on my own!" TouchŽ. Still, there are a
couple of very common obstacles that can be overcome by doing IUI.
One of these is poor or failed post-coital testing (see Diagnosing
Infertility, Cervical
Factors).
In these couples, there is no clear-cut infertility problem except that
the female partner’s cervical mucus and the male partner’s sperm don’t
seem to be compatible for one reason or another resulting in the
failure of motile sperm to pass through the cervix and into the uterus
on their own. This is where IUI proves useful. Sperm are loaded into a
long, thin catheter and simply passed through the inhospitable cervical
mucus and into the uterus where the sperm are injected. Now there’s
nothing but daylight (figure of speech - actually, it’s pretty dark in
there) between the sperm and the unsuspecting egg(s).
Another area
of minor infertility which IUI can help remedy is in cases of low sperm
count. Though the sperm must have decent motility and function, the
fact that a man has a low number of them can put him at a disadvantage
when using intercourse as the method of conception. Even if the
cervical mucus is not a factor, a huge number of sperm (most, in fact)
will never complete the journey to the fallopian tubes because they run
out of energy, take a wrong turn and refuse to ask for directions
(sperm do come from men, you know), and so on. So someone who
has a low number of motile sperm is less likely to be adequately
represented when that egg makes its way down the tube. IUI allows the
sperm to be prepared and concentrated in the laboratory (see Reproductive Assays Laboratory to
read how the sperm preparation is performed) and then deposited in the
uterus. As a result, you have many more motile sperm in the uterus than
there would be normally, all with a full tank of gas.
More sperm, with more energy reserves, with less distance to travel –
makes sense, doesn’t it? Incidently, the non-pregnant uterus (picture
it like a closed fist) can only hold a volume of 0.5 mL of fluid before
the fluid re-fluxes back out. The average semen sample is between 2.0
and 4.0 mL. The idea, then, is to put as much motile sperm in that 0.5
mL as possible. That end is not achieved if you just take 0.5 mL of
unwashed sperm since you’d be leaving much of the specimen behind. By
preparing the specimen in the lab, the majority of motile sperm are
able to be concentrated into a 0.5 mL volume by separating them from
the remaining volumes of semen, cellular debris, immotile sperm, etc.
How
The Technique Works
The use of fertility drugs in conjunction with IUI is quite common,
even in couples without a diagnosed ovulatory disorder. As discussed in
Ovulation Induction,
ovulation can be stimulated with a course of hormone treatment, either
with clomiphene citrate or injectible gonadotropins. Cycle monitoring
can be performed by GYFT clinical staff using ultrasounds and serum
estrogen levels. Monitoring is particularly important due to the fact
that several eggs can be produced in response to these medications and
the chance of pregnancy is increased due to the placement of the sperm
in the uterus. Thus, if too many follicles develop, there can be a risk
of multiple pregnancy – which is something we try to avoid. Ideally,
the aim is to generate between 3 to 5 eggs in an IUI cycle, which
statistically gives the best chance at a single pregnancy. When 2 or 3
follicles have reached their proper size, ovulation is induced (using
HCG injection) or detected (using an ovulation predictor kit) and your
infertility specialist will schedule the time of the IUI (usually
within the 24 to 36 hours following) and the time for the sperm
specimen to be brought to the lab. If the male partner will be
providing the sperm, the specimen should be received in the lab
approximately 2 hours before the scheduled IUI time so that the lab can
adequately prepare the sperm for insemination. If a sperm donor is to
be used (these specimens are usually frozen), the lab is notified of
the IUI time so the specimen can be ready when the patient arrives. The
IUI procedure itself is performed by one of our skilled fertility
nurses by loading the washed sperm specimen into a long, fine catheter
and inserting it through the cervix and injecting the sperm high into
the uterus of the female partner. The procedure is quite painless and
takes all of a minute or two. The nurse will have the patient lay down
for about 20 minutes to give the sperm a nice head start without having
to fight the forces of gravity when standing, and then she’s free to
go. If desired, a follow-up appointment can be made for a day or two
later in order to confirm ovulation by ultrasound. A pregnancy test can
be done two weeks later.
Sperm
Donors
In cases of male infertility where the male partner’s sperm is severely
abnormal, either because of a very low count, total absence of sperm,
or extremely poor movement (and ART is not an
option), donor sperm is readily available from commercial sperm banks
across the country. Frozen donor specimens can be ordered and shipped
to your fertility clinic overnight, and once thawed are every bit as
effective in achieving a pregnancy as a freshly collected specimen.
Donors are anonymous and meticulously screened for fertility potential
and absence of inherited and sexually transmitted diseases. Sperm
donors have traditionally been chosen by clients solely on their
physical characteristics, blood type, education, occupation, interests,
etc., but still remain entirely anonymous. There are some commercial
banks that stretch the definition of "anonymous," however, and will let
clients come just shy of meeting them through the issuance of photos,
taped interviews, and even video taped discussions. Check out some of
the cryobank links at left to find out more.
cryobank.html
Risks
of IUI Treatment
Complications resulting from IUI are infrequent, but can include
infection, brief uterine cramping, or transmission of venereal disease
if being inseminated with sperm from a person who has not been
appropriately screened (GYFT requires all couples to undergo STD
screening prior to treatment, so this complication has been effectively
eliminated).
Ovarian
Hyperstimulation Syndrome
Stimulating the ovaries with fertility medications comes with its own
set of complications. As mentioned above, multiple pregnancy is a risk
when several follicles develop beyond a certain size. If your
infertility doctor finds the risk too great, he might discontinue
treatment or recommend converting the cycle to IVF. We try to avoid
excessive multiples (three or more) at all cost as multiple pregnancies
are associated with higher rates of miscarriage and pre-term delivery.
Ovarian Hyperstimulation Syndrome is a fairly uncommon condition which
results in pain in the abdomen caused by enlarged ovaries and a
collection of fluid in the abdomen due to excessive stimulation from
fertility drugs. This condition does not usually require
hospitalization and will resolve on its own once the medication is
stopped. If the pain becomes too uncomfortable for the patient, the
abdominal fluid can be aspirated during a quick in-office procedure.
Chance
of Success
The success rates of superovulation and IUI are around 20% provided
that the male partner’s sperm count is within certain limits and the
female’s tubes are healthy.
If we see success with IUI, it usually occurs within one to
five attempts. If not, there tends to be some underlying factor causing
the infertility and depending on the age of the female partner, the
doctor may recommend a more aggressive treatment such as IVF. IUI is
currently a very popular and quite successful treatment for
infertility. Although it is not as successful as IVF on a per cycle
basis, it is a less traumatic and less expensive method of treatment.
