Intrauterine insemination (IUI): when it makes sense (and avoid DIY)

Intrauterine insemination ( IUI ) is one of the most used methods in assisted reproduction. I recently received questions about “do it yourself”, perhaps inspired by Jennifer Aniston’s film “Two Hearts and a Test Tube”, but believe me, movies are… movies, the reality is quite different.

In an IUI procedure, the collected sperm is specially prepared before being inserted into the catheter: in fact, the sperm is washed with special substances. This is because semen normally contains proteins and other natural compounds that would naturally be filtered towards the ascent.

If sperm were injected without this treatment, they could cause cramping, nausea and vomiting in the woman. In short, do not attempt all of this at home with improper, non-sterile instruments and with inadequately prepared sperm.

When does it make sense to resort to IUI?

During intercourse, sperm cells are deposited in the vagina and swim through the cervix and into the uterus. IUI does nothing but place the (processed) sperm directly into the uterus.

IUI is used for example in the case of heterologous fertilization , when one’s partner has a diagnosis of azoospermia (absence of sperm) and sperm is obtained from an external donor. Couples of women also resort to IUI with an external donor.

Another common situation is an IUI with frozen samples of your partner’s sperm, taken before chemotherapy treatment for example, or before a mission abroad (this if your partner is in the armed forces).

There are also many single women who resort to this treatment.

In case the man has low quality sperm. the IUI is not the best choice even if it remains the cheapest choice. In cases of reduced male fertility it is preferable to resort to more expensive methods of fertilization but which give better results such as ICSI . Intracytoplasmic sperm injection is nearly 5 times more effective than IUI.

It may happen that the process of washing and preparing the sperm for IUI helps to overcome a “quality” problem and consequently, precisely because of a question of costs, some are inclined to make attempts at IUI anyway.

Deciding whether to try first with IUI or with ICSI directly, is a choice that should be made by the specialists together with the couple and on the basis of the fertility situation of both (and sometimes also on the basis of the economic situation of the couple itself).

 When does IUI offer no benefit?

Obviously when the tubes are not patent and therefore do not allow sperm to travel to the ovaries.

IUI is also not recommended in cases of uterine abnormalities, fibroids and severe endometriosis: these are not the best scenarios because  simply depositing   sperm in the uterus offers no obvious benefit.

If the woman suffers from irregular menstrual cycles, for example due to polycystic ovary syndrome (PCOS)   , ovulation  occurs sporadically in these  situations . The problem could be solved with drugs that stimulate  ovulation  and with ultrasound monitoring that indicate when to have intercourse. In this mess the IUI would be of no further benefit.

How many attempts does it take to get pregnant with IUI?

While it takes an average of 5 months for a healthy couple who have regular targeted intercourse to conceive a child, IUI is about the same time frame. In the US it takes an average of about 4 months (4 attempts). Times are shortened slightly because in general the IUI provides for ultrasound monitoring that allows the transfer of sperm in a timely manner and in the best times compared to the woman’s ovulation.

If fertility drugs are used in combination, it is possible to slightly increase the success rate, but in this case the costs of the procedure also increase.

If an external donor is also used, the costs can rise further