What is IUI?

Intrauterine insemination (IUI) is a form of assisted conception. During IUI, your doctor will place washed, prepared sperm into your uterus (womb) and near to your egg at your time of ovulation. This procedure is often combined with fertility drugs to increase your chances of conceiving.

Could IUI benefit us?

IUI may help you as a couple if:

·         Your spouse has a borderline low sperm count or low motility. This is when the sperm's ability to move is impaired. But there must be enough healthy, motile sperm to make the treatment worthwhile. If not, IVF or ICSI may be more suitable.

·         You are unable to have sex because of disability, injury, or if your partner experiences premature ejaculation.

·         You have mild endometriosis.

·         You or your spouse's fertility problems are unexplained.

For IUI to work, your fallopian tubes must be open and healthy. To find this out, you will need to have a tubal patency test. This can be done using laparoscopy, which is a form of keyhole surgery, or a hysterosalpingogram, which is a form of X-ray. These may locate any problems or blockages in your uterus or fallopian tubes.

IUI isn't recommended if your tubes have adhesions or scarring that might stop an egg travelling from the ovary to your uterus. But if you have at least one working tube and ovary, IUI may be an option for you.

How is IUI carried out?

Depending on your particular fertility problem, you may need to use fertility drugs alongside your IUI treatment. If you do take fertility drugs it's called a stimulated cycle, because the drugs stimulate ovulation. If drugs are not used it's called an unstimulated cycle, or natural cycle. 

While experts agree that the stimulated cycle has a higher chance of pregnancy compared to a natural IUI cycle, this needs to balanced with the increased risk of multiple pregnancy inherent in a stimulated cycle.

You may think that twins or more would be a great way to start a family if you have fertility problems. But multiple pregnancies increase your risk of miscarriage and other pregnancy complications.

In unstimulated cycles, IUI is timed to take place at the time of natural ovulation. You may be asked to detect ovulation using an ovulation predictor kit, or your doctor may track your cycle using blood tests and ultrasound scans. IUI is usually done between day 12 and day 16 of a natural menstrual cycle, but the exact day will depend on your individual cycle. 

If your fertility specialist has offered IUI during a stimulated cycle, you'll probably be given fertility drugs in the form of tablets or injections. You'll start taking the drug near the beginning of your menstrual cycle. 

An ultrasound scan helps to locate the egg and check that it is mature. This will allow insemination to take place at the best time. You may ovulate naturally, or be given an injection of a hormone called human chorionic gonadotrophin (hCG) to bring it on. 

Your partner will be asked to provide a sperm sample, which will be washed to extract the best quality and most mobile sperm. That sperm is then inserted into your uterus within 24 hours and 40 hours of the hCG injection, or when you have a rise (surge) in luteinising hormone (LH). 
Using a catheter (tube) through your cervix, your doctor will put the sperm directly into your uterus near a fallopian tube. This is the passage the egg travels along from an ovary to your uterus. 

After IUI you will rest for a short time and then carry on life as normal. You'll be able to take a pregnancy test in about two weeks.

How long will treatment last?

The insemination itself is straightforward and takes only a few minutes. If you are having a stimulated cycle, you'll need to take fertility drugs before you ovulate.

There is no limit on how many cycles of IUI you can undertake if you are using your partner's sperm. If donor sperm is used there is usually a limit, which varies from clinic to clinic and from state to state, depending on donor sperm availability. Most fertility units would restrict the number of IUI cycles with donor sperm to two or three attempts. If you are not successful, IVF with the same donor would then be offered.

Are there any downsides to IUI?

Despite the benefits, IUI is not for everyone.

·         The timing of the insemination is crucial, so your partner must be able to produce a sperm sample by ejaculating into a cup on demand at the clinic.

·         It may be uncomfortable if it proves difficult to insert the catheter. And the procedure may cause cramps similar to period pains.

·         With stimulated cycles there is a very small risk of developing ovarian hyperstimulation syndrome (OHSS). This serious condition happens when your ovaries respond too well to the fertility drugs that cause you to ovulate. The ovaries rapidly swell up to several times their normal size and can leak fluid into your tummy, making you gain weight and feel full and bloated.

It's vital that you seek medical help if you think you are experiencing OHSS. You may need to stay in hospital while your ovaries settle down, and your doctor will probably advise cancelling your IUI treatment for this cycle. That's because the risks of conceiving a multiple pregnancy will be too great.