Intra-Uterine Insemination (IUI)

Intra-Uterine insemination (IUI) is the technique of placing specially prepared sperm from either a partner or a donor directly into the uterus. IUI is used in cases of unexplained infertility and some cases of male factor infertility. Unless IUI is being used in combination with donor sperm therapy or to treat specific conditions such as psychosexual problems or problems with ejaculation, there is little evidence that pregnancy rates are improved appreciably unless fertility drugs are used in combination with IUI. However, it is an option which may be considered before advanced procedures such as in-vitro fertilization (IVF). A full semen assessment should be performed to determine whether the partner's sperm sample is suitable for IUI. The analysis documents the sperm count and motility, whether the sperm are normally formed, and the presence of anti-sperm antibodies. A minimum of 5 million motile sperm are usually necessary if IUI is to be worthwhile.

Semen consists of two elements - the sperm cells themselves and the liquid (seminal plasma) which makes up most of the ejaculate volume. Seminal plasma contains chemicals called prostaglandins that can cause painful uterine cramps and must be 'washed' or removed before IUI. During the washing process the motile sperm are selected in order to be used for insemination.

The motile sperm are placed into the uterus with a thin plastic tube which is passed through the cervix as in the above diagram. The procedure is usually painless and requires only a few minutes. About 10% of women will experience temporary menstrual like cramping. After the procedure all normal activities can be resumed.

Sperm washing removes most of the bacteria from the ejaculate but neither the sperm nor the cervix can be completely sterilized. There is always the slight chance an IUI could produce an infection in the uterus called endometritis, or of the uterus and fallopian tubes called pelvic inflammatory disease. This is an uncommon occurrence with a risk less than 1%. Symptoms of an infection include lower abdominal pain and fever. Mild cases can be treated with oral antibiotics but moderate or severe infections can require hospitalization for treatment with intravenous antibiotics. Occasionally even after washing, the sperm may irritate the pelvis and mimic an infection. This may cause discomfort and bloating.