Intra-Uterine Insemination (IUI)
Intra-Uterine Insemination (IUI) is commonly known as artificial insemination. This has been in use for over 100 years. Artificial insemination includes intra-vaginal, intra-cervical and intra-uterine insemination. The first two procedures were used in the past, but IUI is the most commonly used procedure nowadays. IUI can be performed with the partner’s sperm or donor sperm. Regarding the use of donor sperm, please refer to the sperm donation section.
IUI is a very simple technique whereby washed sperm is deposited into the uterine cavity around the time of ovulation. This can be performed in a natural cycle or a stimulated cycle. The ovaries can be stimulated with ovulatory stimulant tablets (anti-oestrogen tablets) alone or in combination with Gonadotrophins (FSH injections). The dose of anti-oestrogen tablet is usually 50-100 mg daily from day two to day six of the cycle and the dose of FSH injection is 50-150 IU on alternate days starting from the second day.
Monitoring of the cycle is done by serial ultrasound scanning from day nine/day ten of the cycle. When there are two to three follicles of at least 18 mm in diameter, the trigger injection of 5000 IU of human Chorionic Gonadotrophin (HCG) is administered. IUI is usually carried out 24 hours after the injection. In some cases two inseminations are performed on consecutive days if the patients request it.
The logic behind IUI treatment is threefold:
1. More than one egg is available thereby increasing the chance of success
2. Sperm are directly placed in the uterine cavity thereby reducing the destruction of sperm by the vaginal acidity and cervical hostility
3. It also reduces the distance the sperm have to travel to meet the egg in the fallopian tube
Who will benefit from this treatment?
- Couple with unexplained infertility
- Women with mild endometriosis but with open tubes
- Couple with infertility due to a mild male factor
- Women with cervical hostility
- In couples where full penetrative intercourse in not feasible
- When men are unable to ejaculate inside the partner’s vagina
The success rate is usually around 15-20%. Success rate, of course, varies with the age of the woman, and cause of infertility, as shown in the figure below.
Advantages compared to IVF
- Less invasive
- Less emotional commitment
- Less expensive
- Less time consuming
Disadvantages compared to IVF
- Fertilization is not confirmed
- Woman must have open tubes
- Risk of ovarian hyper-stimulation syndrome
- Risk of multiple pregnancies