In our new blog series, we’re breaking down myths and medical jargon to give a comprehensive guide to infertility treatments. This week, we’re discussing IUI.
What is IUI and what do I need to know about 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 inserted in to the catheter, leading it directly to the womb. The aim is to get the sample as close to the released egg as possible.
You may decide to use your partner’s sperm or donor sperm. If using your partner’s sperm, he’ll be asked to produce a sperm sample on the day of your procedure. The sperm sample can be ‘prepared’ in a number of 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.
Timing is key
It is important to time IUI so the sperm reaches the egg at the right time. Ideally, you should have IUI 6 hours prior to, or after ovulation. If your cycle is regular, it’s possible to work out the approximate ovulation time yourself. Ovulation is usually 12-16 days after your period. You can use an ovulation prediction kit (OPK) to help narrow down the window, and in some cases, blood tests.
Your doctor may prescribe medicine to help stimulate the release of one or two eggs before the procedure. This is known as stimulated IUI or super-ovulation. A cycle of stimulated IUI is closely monitored with ultrasound scans. Firstly, to determine the timing of ovulation which helps to increase the chances of success. Secondly, to reduce the risk of multiple pregnancy (twins, triplets or more!)
Is IUI 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. IUI isn’t routinely offered to other couples. This is because evidence shows success rates aren’t much better than that of regular sexual intercourse.
You can also access IUI privately. Female same-sex couples and single women who want a baby are only be eligible for NHS-funded IVF treatment if they’ve had 6 cycles of unsuccessful IUI in a clinical setting. You would’ve had to self-fund this IUI treatment.
You and your partner’s fertility will be assessed, to ensure IUI is right for you. IUI is unlikely to be successful if the cause of your infertility is low sperm count, endometriosis, or damaged fallopian tubes. Your doctor should discuss this with you.
What are the risks?
IUI is a fairly simple medical procedure. Whilst the woman being inseminated might experience some discomfort, serious risks are minimal.
Lower abdominal cramps, similar to period pain, are not uncommon. However, most women have the procedure and return to their day as usual.
Fertility medications (such as Clomid, Letrozole, and hMG) can come with side effects. These include headaches, fatigue and affected mood because of hormone changes. These side effects may include the potential risks of multiple pregnancy and ovarian hyper-stimulation syndrome.
How successful is IUI?
Whilst less expensive and less invasive than IVF, treatment with IUI is less successful. As with all fertility treatments, the woman’s age has a significant impact on success.
Your doctor also takes into account how long you’ve been trying to conceive. They also look at the underlying reasons for subfertility when deciding if IUI is right for you. The average couple has a 20% chance of getting pregnant with each menstrual cycle. After one year of trying, this falls to 1.5-3%. So, it’s important that any treatment offered can give better odds than this.
Using frozen sperm is less successful than fresh sperm. Do keep this in mind if using donor sperm. You can increase the chances of conceiving via IUI by taking medication (eg. clomiphene) to stimulate ovulation. You can also monitor your cycle carefully so you have the procedure at the optimal time for fertilisation.
