In vitro fertilization (IVF) may be the most well-known treatment method, but depending on your situation and your reproductive endocrinologist's recommendations, you may want to consider other fertility treatment options like intrauterine insemination (IUI).
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What is Intrauterine Insemination (IUI)?
The IUI procedure allows the placement of a concentrated sample of motile sperm directly into your uterus, thereby increasing your chance of fertilization and conception, as some common barriers in the female reproductive tract are bypassed.
Sperm motility describes the ability of sperm to move properly through the female reproductive tract in order to reach the egg. It can also refer to the quality of sperm, which is a major factor in the conception process. Non-motile sperm are identified as sperm that do not "swim" properly and won't be able to reach an egg in order to successfully fertilize it.
How can IUI help me conceive?
Normally, during intercourse, millions of sperm are deposited in the woman’s vagina in the hope that at least a few hundred will make it to the site of implantation - the fallopian tubes. In sperm terms, that’s pretty far away!
Sperm must travel all the way to the egg and this journey is fraught with many barriers. Think of it like an obstacle course for sperm. This lengthy journey can be a reason for infertility in some people.
Some barriers are the acidic environment of the vagina and mucus produced by the cervix that is detrimental to sperm most days of the month. That may sound intense, but this security guard-like interference is actually a good thing…most of the time.
One of the "jobs" of the cervix is to safeguard the uterus (which is sterile) from anything entering the vagina that can be a possible cause of infection. This is great! However, in its protective role, it can prevent the passage of sperm - bad news for those trying to conceive.
Here's how IUI can help:
Depositing sperm directly into the uterus via an IUI bypasses the vagina and cervix, giving sperm a better chance of reaching the egg and successfully fertilizing it (AKA conception).
How much does IUI cost?
Treatment and medication costs will vary. Without fertility insurance coverage (AKA paying out-of-pocket), you can expect to pay anywhere from $3,830-$7,000 for each IUI cycle. With insurance coverage, the cost per cycle usually decreases.
Learn more about fertility treatment costs at Illume Fertility here.
The timing of an IUI is important and must be calculated based on your natural or induced ovulation. If natural ovulation is allowed to occur, the IUI should be scheduled the day of or the day after your over-the-counter urine ovulation predictor kit (OPK) test line turns positive.
At Illume Fertility, we often recommend a medicated IUI cycle to patients who are good candidates for IUI. A medicated cycle combines IUI with ovulation induction medications in order to increase the number of eggs that are produced, matured and available for fertilization that month.
If you are undergoing a medicated cycle, you will be given a "trigger" injection which mimics your natural LH (pre-ovulation) surge. These trigger shots allow us to precisely time your ovulation and perform an insemination 24 to 36 hours later to ensure that sperm are present in the reproductive tract before you ovulate (sperm live longer than eggs, so we want the sperm to be there 'waiting' for the egg).
What does an IUI feel like?
The IUI process itself is relatively simple and painless. Most women report that it feels like a pap smear (or that they didn't feel much at all during the procedure). The flexible catheter that it is inserted into your vagina is so small, you can't really feel it!
IUI Procedure Step-by-Step
Step 1: Sperm Production
On the morning of the IUI, the male partner produces a sperm sample in a collection room via masturbation (if donor sperm is being used, it is thawed at this time).
Step 2: Sperm Preparation
The sperm sample is assessed under a microscope and the total number of moving sperm (TMS) is calculated. The sample is then "washed" - a process where any bacteria or substances that can be potentially irritating to your body or detrimental to fertilization are removed.
The final (washed) sample is then reviewed by an andrologist and the TMS are recalculated and recorded. The sample is then placed in a vial with your name on it.
Step 3: Insemination
Before your IUI procedure, you will be asked to confirm your name and identifying information on the vial containing the washed sperm sample. Once confirmed, the sample is drawn up into a flexible catheter which is inserted through the cervical canal into your uterus.
Do I have to lie down afterwards? We do ask that you remain relaxed on the table for a few minutes after insemination to ensure you are not having any cramping or adverse reaction to the procedure or the sperm wash (which is very rare). However, laying down does not increase your overall chances of success - it's simply a safety measure.
Step 4: Wait
Now comes the most un-fun part of the process...waiting! (We know that two week wait can be really difficult.) Once your IUI procedure has been completed, you can go home or back to work and continue your day as usual.
A pregnancy test is scheduled for approximately 14 days after your IUI procedure.
Note: Your doctor may suggest you come into the office for IUI two days in a row in order to maximize your chances of success that cycle. You will discuss this together.
IUI Success Rates
The chance of conception after IUI varies and is dependent on multiple factors, such as the cause of infertility, the presence (and severity) of a male factor fertility issue, your age, and the quality of the sperm sample used on the day of your procedure.
When we have an adequate sperm sample, and in the absence of advanced age or poor ovarian reserve, there is a 15-20% chance of achieving a pregnancy that cycle when combined with oral ovulation induction medications.
We usually recommend three months of trying with natural or medicated IUIs before consulting your physician about next steps.
At Illume Fertility, we require a minimum of five million total motile sperm (TMS) in order to proceed with an IUI. This is because your chances of pregnancy are very low when the TMS are less than five million. We always prefer that the sample is >10 million TMS.
Is IUI right for me?
The answer depends on your situation!
IUI is used very frequently as a fertility treatment and many individuals and couples achieve success with this method. It’s imperative to complete your diagnostic fertility testing prior to starting treatment so that you and your reproductive endocrinologist can come up with a plan that is right for you.
It’s also important to note that some insurance companies mandate a set number of IUI cycles prior to advancing to IVF. This can affect your treatment plan if insurance is covering part or all of your expenses. If you are an Illume Fertility patient, ask your Insurance & Billing Advocate for assistance in determining whether this is the case for you.
Whether you start with IUI treatment or utilize other technologies offered by your fertility practice, it’s important to find a Care Team that always has your best interests at heart. This is a major step toward your family-building success, and we can’t wait to help you get there!
Monica Moore is a board-certified Advanced Practice Nurse Practitioner, nurse educator and health coach who has been caring for patients at Illume Fertility for over 20 years. She is also the founder and lead educator at Fertile Health, LLC. Monica is passionate about taking care of the whole patient, believing in the importance of integrating comprehensive care. She has a special interest in PCOS and combating weight bias with education and advocacy.