If you’re considering different fertility treatments, including Intrauterine Insemination (IUI), understanding the difference between IUI vs. IVF (In vitro fertilization) is crucial. This includes understanding the science behind the IUI procedure, how the IUI process gets conducted at Arizona Center for Reproductive Endocrinology and Infertility, and the keys to a successful IUI procedure.

What is Intrauterine Insemination? 

When deciding if IUI is right for you, it is important to understand what is involved in the procedure. Intrauterine insemination, commonly known as an IUI, is a popular, cost-effective infertility treatment in which a concentrated amount of motile (active) sperm is fed through a catheter directly into a patient’s uterus to increase the chances of conception. 

The procedure itself is a straightforward, fast process. Patients will lie on an exam table with their legs elevated in stirrups, as with most gynecological procedures. A speculum will be used to create a passageway for the catheter to be inserted through the cervix and into the uterus. Once this is in place, the motile sperm solution will be run through the catheter, which will then be removed along with the speculum. The patient will rest for a short time before continuing their routine as normal. 

The procedure is generally considered very safe. However, potential side effects include infection, spotting, or multiple pregnancies due to the consumption of reproductive hormones.

History of IUI 

Experiments with assisted reproduction in animals have been practiced for several centuries. The first successful example of artificial insemination in human beings occurred in the late 1700s when Dr. John Hunter was able to help a woman struggling with infertility become pregnant with her husband’s sperm. The first successful human pregnancy from IUI of frozen sperm was in 1953. Today, IUI treatment is commonplace, safe, affordable, and effective.

Why should I consider IUI? 

IUI is a procedure recommended for heterosexual couples experiencing fertility issues, same-sex couples looking to undergo artificial insemination, and single mothers looking to start a family of their own.

Patients struggling with infertility should consider IUI a good starting point if one of the following factors is at play in their fertility struggles:

1. Male-factor infertility can be caused by various factors, resulting in low or inactive sperm. 
2. Cervical-factor infertility, in which the cervical mucus does not provide ideal conditions around the time of ovulation to increase the sperm’s ability to move towards the egg. 
3. Endometriosis, uterine scarring following endometrial ablation, postpartum Dilation and Curettage, and low levels of estrogen production may all be factored in having a low endometrium lining and difficulty in conceiving. 
4. Patients interested in pursuing donor insemination, especially when using frozen and thawed donor sperm, should consider IUI to increase the likelihood of conception.
5. Some patients undergo an IUI even when there are no determinable fertility issues to increase the likelihood of conception because the procedure localizes the fertilization process and increases the chances of pregnancy. It can increase the normal monthly conception rate from 1-3% to 5-10% on average. 

The difference between IUI vs. IVF? 

Although IUI and IVF are forms of assisted reproduction techniques, each requiring the use of reproductive hormones, the key difference between IUI vs. IVF is in how the eggs get fertilized. The IUI procedure can be understood as a method of accentuating a natural conception process through localizing the point of insemination. IVF is a more involved process in which the ovum is extracted from a patient’s uterus, and external fertilization occurs before eggs are re-inserted into the patient’s uterus.

Both procedures usually use ultrasound to track the patient’s egg production within the uterine follicles. The consumption of reproductive hormones often accompanies these procedures. This may include clomiphene citrate or Clomid, which is taken orally to simulate higher estrogen levels resulting in the release of follicle stimulating hormones to encourage egg production.  This is sometimes taken in conjunction with what is commonly called a “trigger shot,” which can vary from several different medications, including Ovidrel, Novarel, or Pregnyl, all of which contain human chorionic gonadotropin (hCG). It is administered just before ovulation occurs and helps aid in the process of releasing mature eggs from the uterus to prepare for conception. In IVF, a trigger shot is used in anticipation of egg retrieval; in IUI’s, it is used in conjunction with ovulation to ensure that implantation is successful. 

IUI does have a high success rate and, when used properly, can prevent the need for in-vitro fertilization. It is more cost-effective, less invasive than an IVF procedure, and is often not painful for the patient. IVF is one of the most successful methods of assisted conception and can be a great option for bypassing the fallopian tubes for patients experiencing damaged or absent tubes. However, it is more expensive and invasive than the IUI procedure. Many factors should be considered and discussed with your physician when determining which procedure is best for a patient. For more information about the differences between IUI and IVF, we recommend reading through Arizona Center for Reproductive Endocrinology and Infertility articles on our blog site, including The Complete Guide to the IVF Process. 

Where do we start with the IUI process? 

When considering an IUI, patients will begin by undergoing a semen analysis to determine if there are any abnormalities leading to a low sperm count. The first step in that analysis is an exam and hormone testing to determine the issue’s root. According to Dr. Gelety, close to ninety percent of the time, the root cause of the issue is idiopathic or indeterminable through testing, potentially the result of an injury earlier in life. 

During typical intercourse, much of the sperm that are ejaculated into the vagina is lost en route to the fallopian tubes. Traditional artificial insemination simply introduces the sperm to the vagina rather than directly into the uterus. During a vaginal insemination process, it is difficult to determine how many sperm will have survived a thawing process and make their way through a potentially hostile cervical mucus into the uterus for fertilization. On the other hand, the sperm harvested for the IUI procedure is typically low in volume but high in concentration as it has been cleaned free of plasma and sorted for the most viable sperm.

Dr. Rebecca Reus, an embryologist from the University of Valencia, states that the ideal motile sperm count for undergoing an IUI procedure is above 5 million sperm per milliliter (ml) for a procedure to be successful. Patients with twenty to thirty million per ml of semen before washing and sorting has taken place is an ideal range. Patients with lower sperm counts may want to consider IVF or other forms of fertility treatments.

The clinic may undergo further testing after intercourse on the night before or the morning post-coital test to check how the sperm and cervical mucus interact during ovulation. This can highlight potential cervical inflammation or any sperm antibodies which may be preventing fertilization to help determine whether an IUI is a recommended procedure, but it is not a fool-proof diagnosis method. A test may result poorly, but natural conception could still occur. 

Keys to a successful IUI 

The most important thing in ensuring a successful IUI is that the patient attempts to avoid stressful situations that may reduce the likelihood of a successful IUI. Greeting your appointment feeling knowledgeable and confident in the procedure you are about to undertake can vastly reduce stress and anxiety surrounding an IUI. Consulting with a knowledgeable physician at Arizona Center for Reproductive Endocrinology and Infertility is an important first step in starting your journey.

The use of hormone stimulation can aid in ensuring a successful IUI. Consult your doctor about which hormone treatment is right for you and what side effects these treatments may have. Doing extensive research is essential in researching an IUI procedure. 

Male patients involved in the IUI procedure should avoid ejaculation before giving their semen samples to the doctor. This will increase the volume of sperm available for selection and thereby the likelihood of having a strong motile sample. 

Finally, as with any effort to increase the likelihood of getting pregnant, maintaining a healthy lifestyle is paramount. Habits like staying active, consuming healthy food, getting sufficient rest, and avoiding the consumption of harmful substances such as alcohol, tobacco, and drugs will increase the likelihood of a successful pregnancy.

More information about the IUI process and tips to ensure a successful IUI can be found here and in this informative podcast series. 

Where to go from here

We understand that you may be at the beginning of your journey with infertility, or you may have been researching the best step forward for months or even years. We know that educating yourself on the best step forward can be overwhelming. We hope this article has provided you with a starting point in researching IUI as a potential option for your future. 

To learn more about our procedures at Arizona Center for Reproductive Endocrinology and Infertility, we recommend contacting our clinic at 520-326-0001, subscribing to our newsletter, and following us on social media. We look forward to hearing from you.

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Quite often, when couples who are having difficulty getting pregnant come into the Arizona Center for Reproductive Endocrinology & Infertility for the first time, they arrive with certain perceptions about treatment. Many of them have only heard of in vitro fertilization (IVF) and hormone supplements, and exhale a sigh of relief when we introduce intrauterine insemination (IUI) to them. The procedure is less invasive and less expensive than IVF, and typically has a higher success rate than hormone treatments alone.

Simply put, IUI involves placing sperm inside a woman’s uterus, with the goal of increasing the number of sperm that reaches the fallopian tubes, and consequently, increasing the chance of fertilization. Compared to other techniques, IUI is quick, painless, affordable, and effective, with a relatively low chance of complications.

Here’s a deeper look at the process that has helped so many of our patients have a baby.

 

IUI Success Rate

There are many variables, such as the woman’s age, the cause of infertility, and the type of fertility drugs used, that affect the success rate of individual cases. However, the statistics can be very encouraging.

You should first understand that the normal monthly rate of conception is just 1-3%. With IUI treatments, that rate of success can increase to 10-20% in women under 35, and 5-10% for women older than 40, for every cycle.

 

Candidates for IUI

For many couples, IUI is an excellent first option. It can be an effective solution for many causes of infertility, including:

• Cervical scaring
• Ejaculation issues
• Hostile cervical mucus
• Irregular cycles
• Poor sperm motility

The procedure can also be used in cases when the couple uses a sperm donor or when the man freezes his sperm (before cancer treatment, for example). Same-sex couples can also achieve a pregnancy through IUI; female couples would use a sperm donor and male couples can use their own sperm along with a surrogate/egg donor.

However, with IUI, the woman needs to be able to ovulate, have a healthy ovarian reserve, and a normal uterus.

 

The IUI Treatment Process

With the process, a concentrated amount of sperm is injected directly into a woman’s uterus.

Before completing insemination, you may be required to take ovulation-stimulating medication or hormones. The procedure is timed according to the start of your ovulation—as determined through ultrasounds or urinary LH tests. Once ovulation is detected, IUI is typically scheduled and performed within one to two days to maximize your chances of fertilization.

The male component of IUI involves a semen sample from your partner or a donor. This can be done at home or in our office. It’s recommended that you not have intercourse for 2-3 days before the insemination. That way, your partner can provide a strong sample when needed. The sample is then prepared for insemination through a process called sperm washing, which separates the sperm from the seminal fluid. This also removes chemicals in the semen that can cause a reaction in the uterus and make it more difficult to conceive.

The actual treatment takes only 5-10 minutes and involves minimal discomfort. Our doctor slides a thin, flexible tube through your cervix into your uterus, and using a small syringe, the sperm is flushed through the tube and directly into your uterine cavity.

Some patients may experience mild cramping but side effects are rare.

This process maximizes the number of sperm that reach your uterus and gives them a “head start,” but the sperm must still find and fertilize the egg on its own.

The next step is to watch for signs and symptoms of pregnancy. If pregnancy is not achieved, we may attempt IUI a few more times before moving on to a more complex procedure.

 

Cost

The cost of IUI varies, but it is usually significantly less expensive than other fertility treatments, such as IVF. Cost is usually less than $300 and includes prepping and washing of the sperm and the procedure with our doctor. Our team at AZCREI will always work with you and your insurance provider to minimize the cost as much as possible.

We want you to rest assured that you have options when it comes to overcoming your infertility. IUI is an incredible option to help you finally have a baby. To make an appointment and learn more about IUI options, visit Arizona Center for Reproductive Endocrinology and Infertility online or call us at 520-326-0001.